Femoral neck fracture or femoral neck fracture is an acute condition that occurs more frequently in older people and less in young people or in middle age. This fact also influences the healing time of femoral neck fracture quite significantly.
What is a neck of femur fracture?
Behind the neck of femur fracture, medically exactly also called femur fracture or simply neck of femur fracture, there is a breaking through of the bone in the area of the femur either on the left or right side. The femoral neck fracture is also known as a near-hip fracture due to its typical positioning. A distinction is made between two variants of femoral neck fracture. If it is a stable femoral neck fracture, the course of treatment is quite different from that for an unstable femoral neck fracture. In the case of a femoral neck fracture, different types of fracture are named depending on the localizable fracture sites. In addition to the so-called medial femoral neck fracture, these are the lateral and the pertrochanteric course of the fracture. In the medial fracture, the fracture runs below the femoral head and lies in the joint capsule. If the fracture line in the femoral neck fracture no longer runs in the joint capsule, it is referred to as a lateral fracture. Different therapeutic approaches also result when the fracture line is the one found between the femoral neck and the so-called bone shaft.
Causes
The causes of a femoral neck fracture are usually based on excessive mechanical force. Whether this is due to a fall or an accident, the bone is subjected to such enormous stress in this context that a fracture occurs. The femoral neck fracture is favored by varying circumstances, which is also an indication of the massive accumulation in certain age and person groups. In medicine, the causes of a fracture of the neck of the femur include not only pathological impairments of the bone structure with an increasing instability of the statics of the bone, but also short-term bending and shearing effects, i.e. falls.
Symptoms, complaints and signs
A femoral neck fracture is usually preceded by a fall. The most obvious signs of a femoral neck fracture are severe pain in the hip, or in adjacent areas. For example, there may also be pain in the thigh near the hip, or in the groin area. The affected leg is actively immobile. Passive movement (by the doctor) increases the pain. If the femoral neck fracture occurs as a result of a fall, bruising may be seen on the side of the thigh. If the fracture is a displaced fracture (dislocated fracture), the fractured leg appears shortened compared to the other leg and is rotated outward. The leg can no longer be lifted from the support in an extended position. In this case, often only a visual finding is required, which is then confirmed by an X-ray. Occasionally, a submerged fracture (bone fracture) occurs. In this case the fracture ends do not slip and the symptoms can be very inconspicuous. The patient does not seek medical attention until days later because his symptoms do not improve. The existing pain may be associated with a fall or accident. However, the affected person suspects a bruise behind it, because in some cases he is even still able to walk.
Diagnosis and course
Often, a femoral neck fracture can be detected by a trained eye because of the deformity of the femur and the painful symptoms. These visible symptoms can be confirmed by palpation examinations by the specialist. In addition, an X-ray assessment is necessary, which is usually based on a so-called axial X-ray. X-rays are taken of the affected hip in the case of a femoral neck fracture. Further diagnostic procedures such as computed tomography can be used to provide additional clarification of the extent of the femoral neck fracture in complicated cases.
When should you see a doctor?
A doctor must be consulted even if a fracture of the neck of the femur is suspected. If the fracture occurs in the context of an accident, it is best to call the ambulance, as there may be other fractures or internal injuries. In addition, the risk of joint head necrosis, venous thrombosis and pulmonary embolism increases with each hour.The earlier the fracture is treated, the higher the chances of successful rehabilitation. Severe, stabbing pain in the area of the thigh indicates a fracture of the femoral neck, which must be clarified and treated. Other warning signs include an unusual position of the foot as well as swelling, bleeding or problems moving the affected foot. At-risk groups include the elderly, as well as athletes and people with physically demanding occupations. These individuals should take precautionary measures and, for example, always carry a cell phone so that emergency services can be notified immediately in the event of an emergency. A fracture of the neck of the femur can be treated by an orthopedist. Severe fractures must be treated surgically by the affected person, especially if nerve or muscle injuries are also present. Follow-up treatment is provided by a physical therapist or sports medicine specialist. In the case of severe fractures, it is advisable to stay in a rehabilitation center, where the injury can be cured under the supervision of specialists.
Treatment and therapy
Treatment of femoral neck fracture depends on the diagnosis, whether the fracture is stable or unstable, and the extent of the fracture. If a stable femoral neck fracture is diagnosed, surgery to straighten the fracture can be ruled out. Sufferers are provided with adequate pain management and the fracture is allowed to heal with rest and additional physiotherapy exercises. In the case of an unstable femoral neck fracture, surgical treatment is essential. This is usually the case when the fracture of the neck of the femur has resulted in a displacement of the fracture sites. This problem, which is also called dislocation, can be compensated by different surgical interventions. It is possible to consider either hip preserving therapy or replacement of the hip joint within the modern surgical procedures for femoral neck fracture. In addition, the treatment of a femoral neck fracture by means of the method known as intertrochanteric osteotomy is excellent for young patients. In the first variant, special elements are screwed to the neck of the femur, which re-stabilize the fracture site after a fracture of the neck of the femur. In hip replacement, the surgeon inserts a head prosthesis or a total hip replacement to treat the area and restore mobility.
Outlook and prognosis
The prognosis for a femoral neck fracture depends on how quickly surgical treatment is performed. Normally, the sooner the surgical intervention takes place, the better the prospects for recovery. Often, the prognosis of the femoral neck fracture also depends on the extent of the circulatory disturbance of the femoral head. For this purpose, doctors use a classification according to Garden. In Garden I, there is a positive prognosis with a low risk of necrosis. Garden II also has a low risk of necrosis and no displaced fracture. Garden III is when the fracture has shifted without any displacement of the posterior cortex. In addition, the necrosis rate is high. In Garden IV, the fracture fragments are totally displaced and there is an interruption of the vascular supply. Furthermore, the risk of femoral head necrosis is high. The duration of the healing process for a femoral neck fracture also varies from patient to patient. Factors such as age and the patient’s activities play an important role. In addition, the patient should be mobilized again as quickly as possible after surgery. If, on the other hand, the patient remains lying down for too long, there is a risk of muscle mass loss, which in turn has a negative effect on the prospects of recovery. In contrast, rehabilitation is favorable for the prognosis, helping the patient to recover more quickly and return to his or her daily life.
Prevention
To prevent a fracture of the neck of the femur, it is important to counteract the action of mechanical forces on this area of the hip. In older people, this can be done by making living areas that are at risk of falling barrier-free. In addition, particularly restless persons suffering from dementia can be equipped with so-called protective elements. These are known as protectors and are applied to both the hips and the knees.These aids dampen the impact of force during falls and prevent a fracture of the neck of the femur. Treatment of vertigo symptoms and a calcium-rich diet are also important. Additional physical training as well as adequate fluid intake can reduce the risk of femoral neck fracture, as it were.
Follow-up
If the neck of femur fracture must be operated on, it is important to give the patient injections to prevent possible thrombosis. Injections into the subcutaneous fat tissue can counteract a blood clot. Other useful aftercare measures include the application of special support stockings and physiotherapeutic exercises. One of the goals of aftercare is to mobilize the patient quickly. Already 24 hours after the surgical intervention, the affected person can be mobilized again, which is done under the instructions of a physiotherapist. At the same time, the patient also receives postoperative pain therapy. The postoperative treatment of the femoral neck fracture requires about two to three weeks of hospitalization. During this time, the patient moves with the help of forearm crutches if he or she does not receive load-stabilizing treatment. If the patient has received an artificial hip replacement during the operation, he or she is allowed to put full weight on the leg in question. Lying down for too long is considered counterproductive in the case of a femoral neck fracture. Muscles are broken down in this way and there is a risk of dangerous infections such as pneumonia. As a rule, aftercare continues with rehabilitation after the hospital stay. This can also be carried out on an inpatient basis if care in the patient’s own home is not possible. However, this requires a Barthel index of at least 70. The Barthel index is used to classify the need for care as well as the abilities in everyday life.
What you can do yourself
Unfortunately, patients with a femoral neck fracture can do little to speed up the healing process. On the contrary, patience is the most important virtue. Depending on age, preexisting conditions (osteoporosis, for example), fracture location, and treatment measures performed, it can take up to six months for the femoral neck fracture to heal. If the fracture has been operated on, the area around the wound should be kept clean and sterile, otherwise wound healing problems could occur. Infections are also common complications that can be avoided if the wound is cared for mindfully. Even if they are uncomfortable to wear: Support stockings can prevent thrombosis. Regular physiotherapy can also prevent thromboses and also ensures stable muscles and faster healing. For this reason, patients should be sure to keep physiotherapy appointments. Because it is mostly older people who are affected by a fracture of the neck of the femur, it is advisable to provide all-round care in a hospital or at home for as long as possible. The patient should only put as much weight on the leg as is tolerable in terms of pain. Younger, active patients are even recommended to put only partial weight on the affected leg during the initial period in order to prevent complications. This is where sufferers rely on the help of others.
