Diagnosis

The X-ray image is decisive for the final confirmation of the suspected diagnosis of a femoral neck fracture. As a rule, a pelvic x-ray and an axial x-ray of the hip are taken. In the vast majority of cases, no further diagnostic imaging is necessary.

In young patients who have been exposed to considerable violence, the diagnosis is usually extended by a computed tomography (CT) or magnetic resonance imaging of the hip (MRI of the hip) in order to detect and specify further injuries (e.g. acetabular cup fractures, pelvic fractures, etc.) if necessary. Classifications serve the communication between specialists and allow the derivation of medical therapy measures, which are summarized in recommended guidelines for the individual specialties.

Common classifications of the different fracture types for a femoral neck fracture are those according to Pauwels and Garden. The Pauwels classification is based on the inclination of the fracture surface. The smaller the fracture surface angle, the more stable the fracture.

With increasing fracture surface angle, the risk of false joint formation increases. The Garden classification is based on the position of the femoral head. The risk of femoral head death increases with increasing Garden number.

Pauwels I: Fracture surface < 30° to the horizontal plane
Pauwels II: Fracture surface 30°-70° to the horizontal plane
Pauwels III: Fracture surface > 70° to the horizontal plane
Garden I: Valgian (stable) compressed fracture
Garden II: Non-displaced fracture
Garden III: Varicose (unstable) submerged fracture
Garden IV: Strong fracture displacement

Femoral neck fracture therapy

A fracture of the femoral neck of the femur requires surgical treatment in most cases. Seldom is the fracture so stably immersed that conservative treatment is possible. But even if a femoral neck fracture is stable, a 3-month relief period of the leg is out of the question for most elderly patients.

The resulting immobilization leads in many cases to life-threatening complications such as a Therefore, conservative therapy is reserved for rare young patients who can be mobilized even with complete relief of one leg.

Pneumonia
Leg vein thrombosis or
Pulmonary embolism.

In principle, a distinction is made between operations to preserve or replace the femoral head. Acetabular head preserving operations should be performed as quickly as possible (within 6 hours after the accident) to prevent the risk of death of the femoral head.

Acetabular head preserving therapy options are:

Screw connection: Three screws are inserted through the femoral neck of the femur into the femoral head. The cartilaginous surface of the femoral head is not broken through. The screws should lie as parallel as possible and the screw thread should not cross the fracture line, so that the femoral neck fracture can be immersed under load.
Advantage: Quick operation. Little soft tissue injury. The femoral head and thus the natural hip joint are preserved.

Disadvantage: In case of poor bone substance (osteoporosis), slippage of the fracture or false joint formation (pseudarthrosis) is possible. Immediate full weight bearing is not possible.
Dynamic Hip Screw (DHS): A metal plate screw construction is attached to the thigh. The screw passes through the femoral neck into the femoral head and has the ability to slide like a telescope, causing a compression effect in the fracture area.
Advantage: Quick operation. The femoral head and thus the natural hip joint are preserved. Disadvantage: Slipping of the fracture possible.

Immediate full weight bearing is not possible. Frequent femoral head necrosis.
Artificial hip joint: In geriatric patients with poor bone substance, pre-existing hip joint arthrosis and foreseeable difficulties in mobilization, the implantation of a hip prosthesis may be indicated primarily. Advantage: Immediate pain-adapted full weight bearing is possible.
Easier early mobilization. No slipping of the fracture or death of the femoral head possible. Disadvantage: Major surgery. Greater soft tissue traumatization. In case of prosthesis loosening, replacement operation necessary.