Femoral neck fractures and peritrochanteric fractures are equally prevalent and make up over 90 percent of proximal femur fractures.
The femoral neck is the most common location for a hip fracture. Your hip is a ball and socket joint where your upper leg meets your pelvis. At the top of your femur (which is your thigh bone) is the femoral head. This is the “ball” that sits in the socket. Just below the femoral head is the femoral neck.
Femoral neck fractures are intracapsular fractures. The capsule is the area that contains the fluid that lubricates and nourishes the hip joint. Fractures in this area are categorized based on the location of the fracture along the femoral neck:
- subcapital is the femoral head and neck junction
- transcervical is the mid portion of femoral neck
- basicervical is the base of femoral neck
Though anyone can fracture their femoral neck, it’s considerably more common in elderly adults who have poor bone density. More than 90 percent of these fractures occur in people older than 50. They are more common in women.
A femoral neck fracture can tear the blood vessels and cut off the blood supply to the femoral head. If the blood supply to the femoral head is lost, the bone tissue will die (a process called avascular necrosis), leading to the eventual collapse of the bone. Fractures that occur in places where the blood supply is not disrupted have a better chance of healing.
For these reasons, treatment for an elderly patient with displaced femoral fractures will depend upon the location of the break and the quality of the blood supply.
The standard of care for a displaced fracture where the blood supply is disrupted involves replacing the femoral head (hemiarthroplasty or a total hip arthroplasty). If there’s no displacement, then surgically stabilizing the fracture with screws or other hardware may be done. However, there’s still the risk that the blood supply may be disrupted.
Trauma is the most common cause of femoral neck fractures. Being over the age of 50 or having a medical condition that weakens your bones, such as osteoporosis, increases your risk of a fracture in the femoral neck. Having bone cancer is also a risk factor.
Falls are the most common cause of femoral neck fractures in older adults. In younger people, these fractures most often result from high-energy trauma, such as a vehicle collision or fall from a great height.
Femoral neck fractures are rare in children. Along with high-energy trauma, they can also be caused by low bone mineral density, such as osteopenia or osteoporosis, or by other conditions like cerebral palsy or muscular dystrophy.
The most common symptom of a femoral neck fracture is pain in the groin that gets worse when you put weight on the hip or try to rotate the hip. If your bone is weakened by osteoporosis, cancer, or another medical condition, you might experience groin pain leading up to the time of the fracture.
With a femoral neck fracture, your leg may appear shorter than your uninjured leg, or your leg may be externally rotated with your foot and knee turned outward.
A doctor can usually determine if you have a hip fracture based on the position of your hip and leg, along with your symptoms. After a physical examination, your doctor will use an X-ray to confirm you have a fracture and determine which part of the hip is affected.
Small hairline fractures or incomplete fractures may not show up on an X-ray. If your fracture can’t be seen in the images and you still have symptoms, your doctor may recommend a CT scan, or an MRI or bone scan for a more detailed look.
Treatment of femoral neck fractures usually involves surgery, medication, and rehabilitation.
Pain medication provides short-term relief from pain. This may include over-the-counter (OTC) pain medication, such as nonsteroidal anti-inflammatory drugs (NSAIDs), or prescription drugs, such as opioids.
Your doctor may prescribe bisphosphonates and other osteoporosis medications to help reduce your risk of another hip fracture, depending on your age. These medications help strengthen your bones by increasing your bone density.
Emergency surgery is usually recommended for hip fractures to relieve pain and restore mobility as soon as possible. There are different types of surgery used to treat femoral neck fractures. The type of surgery required will depend on the severity of your fracture, your age, and underlying medical conditions.
Whether your fracture has caused damage to the blood supply to your femoral head will also help determine which type of surgery will be needed.
Internal fixation uses metal pins or screws to hold your bone together so the fracture can heal. The pins or screws are inserted into your bone, or the screws may be attached to a metal plate that runs along your femur.
Partial hip replacement
This procedure is used if the end of the bones is damaged or displaced. It involves removing the head and neck of the femur and replacing it with a metal prosthesis.
Partial hip replacement may also be recommended for adults with other serious medical conditions, rather than a total hip replacement.
Total hip replacement
Total hip replacement involves replacing your upper femur and socket with a prosthesis. Based on research, this type of surgery has the best long-term outcomes in otherwise healthy people who live independently. It’s also the most cost-effective because it often eliminates the need for more surgery later on.
How long it takes you to recover from a femoral neck fracture will depend on the severity of your fracture, your overall state of health, and the type of surgery used. Recovery varies from person to person.
Rehabilitation will be required once you’re discharged from the hospital. Depending on your age and condition, you may be sent home or to a rehabilitation facility.
You’ll need physical therapy to help you regain your strength and ability to walk. This can take up to three months. Most people who have hip surgery to repair a fracture regain most, if not all of their mobility following treatment.
Femoral neck fractures are common in older adults, especially those with bones that have been weakened by other medical conditions.
You may be able to help lower your risk of these and other types of fractures by doing weight-bearing exercises to build strength, and taking calcium supplements to increase your bone density.
Speak to a doctor if you’re concerned about fractures or if you’re experiencing chronic groin or hip pain. These symptoms may indicate that you’re at risk of a hip fracture.