Femoral neck fracture, or femoral neck fracture, is an acute condition that occurs more frequently in older people than in young or middle-aged people. This fact also has a decisive influence on the healing time for femoral neck fractures.
What is a femoral neck fracture?
Behind the femoral neck fracture, medically also known as femur fracture or simply femoral neck fracture, the bone in the thigh area breaks through either on the left or right side. See aviationopedia for Potassium Deficiency Explanations.
Femoral neck fracture is also known as hip fracture due to its typical positioning. A distinction is made between two variants of femoral neck fractures. If it is a stable femoral neck fracture, the therapy is very different than that of an unstable femoral neck fracture.
In the case of a femoral neck fracture, different types of fractures are named depending on the fracture points that can be localized. In addition to the so-called medial femoral neck fracture, these are the lateral and the pertrochanteric fracture course.
In the medial fracture, the fracture runs below the femoral head and lies in the joint capsule. If the fracture line in a femoral neck fracture no longer runs in the joint capsule, it is referred to as a lateral fracture. There are also different therapeutic approaches when it comes to the fracture line, which is 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. Be it a fall or an accident, the bones are put under such enormous strain that they break.
Fractures of the neck of the femur are favored by varying circumstances, which is also an indication of the massive accumulation in certain age groups and groups of people.
In medicine, short-term bending and shearing effects, i.e. falls, are counted among the causes of a femoral neck fracture in addition to pathological impairments of the bone structure with increasing instability of the statics of the bone.
Symptoms, Ailments & Signs
A femoral neck fracture is usually preceded by a fall. The most obvious sign of a femoral neck fracture is 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 no longer actively mobile.
With passive movement (by the doctor), the pain increases. 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 displaced (dislocated fracture), the broken leg appears shortened compared to the other leg and is rotated outwards. The leg can no longer be lifted straight from the base.
Here it often only requires a visual finding, which is then confirmed by an X-ray. Occasionally, a crushed fracture (broken bone) occurs. The broken ends do not slip and the symptoms can be very inconspicuous. The patient takes days to see a doctor because his symptoms are not improving. The existing pain can be associated with a fall or accident. However, the person concerned suspects a bruise behind it, because in some cases he is even still able to walk.
Diagnosis & History
A femoral neck fracture can often be recognized by a trained eye due to the misalignment of the thigh 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 image.
In the case of a femoral neck fracture, the affected hip is X-rayed . In complicated cases, additional diagnostic procedures such as computed tomography can be used to clarify the extent of the femoral neck fracture.
When should you go to the doctor?
If you suspect a femoral neck fracture, you should consult a doctor. If the fracture occurs during an accident, it is best to call an 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 every hour. The earlier the fracture is treated, the higher the chances of successful rehabilitation. Severe, stabbing pain in the thigh area indicates a femoral neck fracture that needs to be clarified and treated. Other warning signs include an unusual position of the foot, swelling, bleeding, or difficulty moving the affected foot.
The risk groups include older people as well as athletes and people with physically demanding jobs. These people should take precautionary measures and, for example, always carry a mobile phone with them so that the emergency services can be called immediately in an emergency. A femoral neck fracture can be treated by an orthopedist. Severe fractures must be treated surgically, especially if there are nerve or muscle injuries. Follow-up treatment is carried out by a physiotherapist or sports physician. In the case of severe fractures, it makes sense to stay in a rehabilitation center where the injury can be cured under the supervision of specialists.
Treatment & Therapy
Treatment of femoral neck fractures depends on the diagnosis, whether the fracture is stable or unstable, and the extent of the fracture. If a stable femoral neck fracture is identified, surgical intervention to correct the fracture can be ruled out. Those affected are provided with adequate pain treatment and the fracture can heal with rest and additional physiotherapy exercises.
Surgical treatment is essential for an unstable femoral neck fracture. This is usually the case when the femoral neck fracture has caused the fracture points to shift. This problem, which is also known as dislocation, can be compensated for by various surgical interventions. There is an option to consider either hip-conserving therapy or hip replacement within modern surgical procedures for femoral neck fractures.
In addition, the treatment of a femoral neck fracture using the method known as intertrochanteric osteotomy is excellent for young patients.
In the first variant, special elements are screwed onto the femoral neck, which stabilize the fracture site again after a femoral neck fracture. In total hip replacement, the surgeon uses a head prosthesis or total hip replacement to treat the area and restore mobility.
Outlook & Forecast
The prognosis for a femoral neck fracture depends on how quickly surgical treatment is performed. The sooner the surgical intervention takes place, the better the chances of recovery are normally.
The prognosis of a femoral neck fracture often also depends on the extent of the circulatory disorders in the femoral head. For this purpose, doctors use a classification according to Garden. Garden I has a positive prognosis with a low risk of necrosis. With Garden II, too, the risk of necrosis is low and there is no displaced fracture. Garden III is when the fracture has displaced without displacement of the posterior cortex. In addition, the necrosis rate is high. In Garden IV, the fracture fragments shift completely and the vascular supply is interrupted. Furthermore, the risk of femoral head necrosis is high.
The healing process for a femoral neck fracture also varies from patient to patient. Factors such as the age and activities of the patient play an important role. In addition, the patient should be mobilized as quickly as possible after an operation. On the other hand, if it stays in place for too long, there is a risk of muscle mass being lost, which in turn has a negative effect on the chances of recovery. On the other hand, rehabilitation that helps the patient to recover more quickly and return to everyday life is favorable for the prognosis.
Prevention
In order to avoid a femoral neck fracture, it is important to counteract the effects of mechanical forces on this hip area. In the case of older people, this can be done by designing areas of life where there is a risk of falling to be barrier-free.
In addition, particularly restless, demented people can be equipped with so-called protective elements. These are known as protectors and are placed on both the hips and knees. These aids absorb the impact of falls and prevent a femoral neck fracture.
The treatment of dizziness symptoms and a calcium-rich diet are also important. Additional physical training and sufficient fluid intake can also reduce the risk of a femoral neck fracture.
Aftercare
If the femoral neck fracture has to be operated on, it is important to give the patient injections to prevent possible thrombosis. Injections into the subcutaneous fatty tissue can counteract a blood clot. Other sensible follow-up measures include putting on special support stockings and doing physiotherapy exercises.
One of the goals of follow-up treatment is to mobilize the patient as quickly as possible. The affected person can be mobilized just 24 hours after the surgical procedure, which is done under the instructions of a physiotherapist. The patient also receives postoperative pain therapy.
A stay in the hospital of around two to three weeks is necessary for the follow-up treatment of the femoral neck fracture. The patient moves with the help of forearm crutches if he does not receive load-stable treatment. If the patient received an artificial hip replacement during the operation, he may put full weight on the respective leg.
Lying down for too long is considered counterproductive in the case of a femoral neck fracture. Muscles are broken down and there is a risk of dangerous infections such as pneumonia. As a rule, the follow-up treatment after the hospital stay is continued with rehabilitation. This can also be carried out on an inpatient basis if care in your own four walls is not possible. However, this requires a Barthel index of at least 70. The Barthel Index is used to classify the need for care and skills in everyday life.
You can do that 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, previous illnesses (e.g. osteoporosis), fracture site and treatment measures carried out, it can take up to six months for the femoral neck fracture to heal.
If the hernia has been operated on, the area around the wound should be kept clean and sterile, otherwise wound healing disorders may occur. Infections are also common complications that can be avoided if the wound is treated carefully. Even if they are uncomfortable to wear, support stockings can prevent thrombosis. Regular physiotherapy can also prevent thrombosis and also ensures stable muscles and faster healing. Therefore, the patient should definitely keep physiotherapy appointments.
Because mostly older people are affected by a femoral neck fracture, it is advisable to receive all-round care in a hospital or at home for as long as possible. The patient may only put weight on the leg to the extent that the pain makes it bearable. Younger, active patients are even recommended to only partially weight-bearing the affected leg initially to prevent complications. Those affected are dependent on the help of others.
