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Femoral Neck Fracture – Causes, Symptoms and Treatment
A femoral neck fracture is a break in the femoral neck, the bone connecting the shaft of the thigh bone to the hip joint. It is most common in older adults following a fall.
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A femoral neck fracture is a break in the femoral neck, the bone connecting the shaft of the thigh bone to the hip joint. It is most common in older adults following a fall.
What Is a Femoral Neck Fracture?
A femoral neck fracture is a break in the femoral neck – the short section of bone that connects the shaft of the femur (thigh bone) to the femoral head (the ball of the hip joint). It is one of the most common and serious fractures in older adults and can significantly affect mobility and quality of life.
Causes
The most frequent cause is a fall from standing height, particularly in older individuals. Contributing risk factors include:
- Osteoporosis: Reduced bone density that makes bones more fragile
- Advanced age: Bone quality naturally decreases with age
- Fall risk factors: Balance disorders, muscle weakness, or side effects of medications
- Nutritional deficiencies: Particularly calcium and vitamin D deficiency
- High-energy trauma: In younger patients due to road traffic accidents or sports injuries
Symptoms
Typical signs of a femoral neck fracture include:
- Severe pain in the hip or groin, sometimes also in the knee
- External rotation and shortening of the affected leg
- Inability to lift the leg or bear weight
- Swelling and bruising around the hip area
- In impacted (non-displaced) fractures: milder symptoms, patient may still be able to walk
Diagnosis
Diagnosis is typically established through:
- Physical examination: Assessment of pain, leg position, and range of motion
- X-ray: Standard method to visualize the fracture in two planes
- Magnetic Resonance Imaging (MRI): Used when X-ray findings are inconclusive, especially for occult (hidden) fractures
- Computed Tomography (CT): For detailed assessment of fracture geometry prior to surgery
Classification
Femoral neck fractures are commonly classified using the Garden Classification (Grades I–IV), which describes the degree of displacement of the bone fragments and guides treatment decisions.
Treatment
Treatment depends on the patient´s age, general health, and the type and extent of the fracture.
Surgical Treatment
Surgery is required in most cases and should ideally be performed within 24–48 hours:
- Internal fixation (osteosynthesis): Stabilization of bone fragments using screws or a sliding hip screw device; preferred in younger patients and minimally displaced fractures
- Total hip replacement (THR): Complete replacement of the hip joint; commonly used in older patients with significantly displaced fractures
- Hemiarthroplasty: Replacement of only the femoral head; suitable for older, less active patients
Non-Surgical Treatment
Conservative management is only considered in rare exceptional cases, such as non-ambulatory patients or those with a very high surgical risk.
Rehabilitation and Prognosis
Early rehabilitation is essential for recovery. The goal is to restore walking ability and independence as quickly as possible. Rehabilitation includes physiotherapy, pain management, and fall prevention strategies. The prognosis depends strongly on age, comorbidities, and the timing of surgery. In older patients, mortality rates in the first year following the fracture are notably elevated.
Prevention
To reduce the risk of a femoral neck fracture, the following measures are recommended:
- Adequate intake of calcium and vitamin D
- Regular physical activity to strengthen muscles and bones
- Treatment of existing osteoporosis
- Fall prevention strategies (non-slip flooring, walking aids, medication review)
- Hip protectors for individuals at high risk of falling
References
- Deutsche Gesellschaft für Unfallchirurgie (DGU): S2e Clinical Guideline on the Treatment of Femoral Neck Fractures, 2022.
- National Institute for Health and Care Excellence (NICE): Hip Fracture: Management. Clinical Guideline CG124, updated 2023.
- Browner BD et al. – Skeletal Trauma: Basic Science, Management, and Reconstruction. 5th ed. Elsevier Saunders, 2014.
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