Muscles at the neck of the femur
Femoral neck fractures are fractures in the area of the neck of the femur (collum femoris) and are located between the femoral head (caput femoris) and the trochanter (bone protrusions at the transition to the femoral shaft). Fractures are divided into medial intracapsular and lateral extracapsular femoral neck fractures. The course of the fracture line is decisive for a prognosis of healing.
According to Pauwels, this can be divided into three prognostically important degrees of severity. In Pauwels I, the fracture lines run up to 30° from the horizontal and there is a favorable prognosis of healing. Pauwels II reaches up to 50° and Pauwels III describes all fracture lines above 50°.
In this case a future high degree of instability of the hip is imminent. The fracture itself is also divided into four degrees of severity. This classification was named after Garden, which describes the degree of dislocation of the fracture.
Garden I describes an incomplete fracture, whereas Garden IV characterizes a complete fracture. Here, the fracture surfaces are displaced from each other and have no contact with each other. If a patient is diagnosed with a fracture of the femoral neck according to Pauwels I and Garden I, physiotherapy is sufficient for healing.
All other degrees of severity must be treated surgically. The fracture of the neck of the femur is a fracture that occurs particularly in older patients over 65 years of age. The reasons for this are that older people fall more often, for example because they have poorer vision or react more slowly.
In addition, people over 65 have weaker bones and are therefore more susceptible to fractures. The mortality rate for a fractured neck of femur is quite high, although the operation itself is a minor complication. More problematic is the long recovery period following the surgical procedure.
The often older patients are bedridden for several weeks and thus run the risk of dying of a secondary disease. Particularly noteworthy are pneumonia, severe inflammation of the wound or even thrombosis. The best therapy, however, is to mobilize the patients as early as possible.
It is extremely important that patients become active and move again during the long healing process (at least 12 weeks). Although this has improved over the last few years, a third of patients still do not fully recover from surgery and even have to be placed in nursing homes. Transient osteoporosis of the neck of the femur is a temporary disease of the hip.
In this case, bone substance in the area of the femoral head and neck often dissolves with an unexplained cause (idiopathic). Patients experience increasing pain under stress and when walking. A limping gait pattern is also noticeable.
It is often difficult to diagnose at an early stage, as only a bone loss of more than 40% is noticeable on X-ray. This disease affects more middle-aged men and is also known as bone marrow edema syndrome (BME). Pain in the neck of the femur is a non-specific symptom and can have various causes.
For one thing, it can be a problem on the femur itself, for example a fracture or bruise. On the other hand, the hip joint can be dislocated (luxated) and it must be put back into the correct position. Furthermore, an inflammatory process can also be the cause of the pain, e.g. an inflammation of the bursa.
A muscular cause must also be considered. A frequent cause is a shortening of the large hip flexor iliopsoas due to sitting for too long and not enough movement. Due to this variety of causes, it is advisable to consult a specialist.
Inflammation can occur on the neck of the femur, which can manifest itself in several symptoms. Often patients describe a pressure pain on the outside of the hip, which is intensified by walking. Possible symptoms are inflammation of the bursa (bursitis) or inflammation of the tendons (trochanterendinosis), which run through the greater trochanter.
Several tendons of different muscles run over the greater trochanter, which are heavily used. Thus, increased irritation is not uncommon at this site. The diseases are treated with medication, physiotherapy, heat or cold therapy and shock wave treatments.
In the case of chronic inflammation, surgical intervention may also be useful.To protect skin, tendons and muscles, bursae are embedded in protruding bones. These can become inflamed if the load is too high and permanent. A typical site for such an inflammation of the bursa (bursitis) is the so-called large trochanter (trochanter major) on the thigh bone.
This leads to an inflammatory reaction and the patient suffers from swelling and pain from pressure. Initially, a conservative therapy with an anti-inflammatory painkiller is used. In addition, the patient should take it easy and avoid physical stress.
The application of cold packs can also bring relief. If these measures do not help, the bursa must be removed surgically. Cysts in the area of the thigh bone are often a chance finding and are diagnosed by means of imaging in the case of a fracture.
Cysts are benign masses that form in the spongiosa of tubular bones. The cancellous bone is the inner part of a bone that consists of so-called bone balls and is therefore less stable than the outer layer (compacta). Since a cyst in the neck of the femur causes the bone to lose stability and a spontaneous bone fracture is imminent, the cyst is usually removed surgically. The resulting cavity is filled with a bone-like substance and the patient can continue living without symptoms.
