Synonyms in a broader sense
Femoral neck fracture, femoral fracture, femoral fracture, Pauwels classification, Garden classification, femoral head necrosis, femoral head death, screwing, DHS = dynamic hip screw, hip prosthesis, osteoporosis
Definition
In a femoral neck fracture, the upper end of the femur breaks just below the head of the femur, usually due to a fall on the lateral hip.
Causes
Older patients (geriatric patients) are predominantly affected by this form of injury. Uncertainty in walking and loss of bone mass (osteoporosis) quickly lead to a fracture of the neck of the femur after falls. In cases of extreme bone loss, even getting up from a chair can lead to a fracture of the femoral neck.
This is then called a pathological spontaneous fracture. In younger patients, considerable force is required before a femoral neck fracture occurs. Occasionally this fracture form looks at this after car accidents or crash injuries.
Patients usually have to be transported to hospital by ambulance. The broken leg is absolutely unable to bear weight. The pain at rest can be mild to unbearable.
The strongest pain always exists when trying to move the leg. Lifting the leg from the examination couch is no longer possible. There is a pressure pain and swelling on the lateral hip region.
The described accident event, combined with the patient’s age and a shortened and outwardly turned leg, are indicative for the doctor’s diagnosis. This typical leg position results from the displaced femoral neck fracture as well as from corresponding muscle traction, with the hip outward twisters predominant. The medial fracture of the femoral neck and so-called pertrochanteric fractures are the most common.
Lateral fractures of the femoral neck are significantly less common. In the case of slightly displaced femoral neck fractures, the described leg position may occasionally be less pronounced or not present at all, and the patient may also experience his main complaints in the area of the knee joint. In this case, a fracture of the neck of the femur can be overlooked.
Injuries to larger vessels or nerves of the leg with corresponding failure symptoms are rather rare. Depending on the type of fracture, however, an interruption of the blood supply to the head of the femoral neck must be expected. However, this cannot be diagnosed exactly.
Therefore, if the femoral head is to be operated on while preserving the femoral head in the event of a fracture and the need for surgery, the worst possible situation must be assumed and the operation must be performed as an urgent operation within 6 hours of the accident. Otherwise the risk of death of the femoral head (femoral head necrosis) increases. As an immediate measure after a femoral neck fracture, the leg is immobilised in a foam splint, effective pain therapy is applied and thrombosis prophylaxis is initiated. As a rule, nowadays we do not apply an extension (pulling on the leg to counteract the shortening).
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