This is a fracture of the upper region of the thigh bone. It may have intracapsular or extracapsular involvement. The location of the lesion at the femoral neck/head is determinant for the type of treatment to be performed.
Femoral Neck Fracture
Subcapital, Trochanteric and Subtrochanteric Fractures
Most occur in older people with bones weakened by osteoporosis as a result of low energy trauma. In young people they usually result from high-energy trauma such as road accidents. The upper region of the femur is composed of the head, neck and trochanteric region. The hip is a joint made up of a sphere that fits into a dome: the sphere is the head of the femur and the dome is the acetabulum (which is part of the pelvis).
It is characterized by acute pain in the groin or upper thigh with an inability to mobilize the hip or knee, place the foot on the ground or walk. It is often associated with shortening and rotation of the affected limb. Most often patients are referred by ambulance to hospital. In sporadic cases, typically in fractures without deviation, patients may be able to mobilize the limb and even do loading although with associated pain. Most of these fractures can be diagnosed with a simple hip radiograph. Small fractures, incomplete fractures and fractures without deviation are only detected using computed tomography or magnetic resonance imaging of the proximal femur.
Most Femoral Neck Fractures require surgical treatment, ideally within the first 48 hours. The aim of surgical treatment is to relieve pain and to allow the earliest possible raising in order to reduce the complications inherent to the alectus. Only a small subgroup of patients without medical conditions for surgery or anaesthesia are treated conservatively.
These fractures can be divided into three types, with important implications for the surgical treatment adopted:
– Subcapital: intracapsular fractures (within the joint).
- a) without deviation: screw fixation through the fracture, so as to hold the femoral head in place while the fracture consolidates.
- b) with deviation: hip prosthesis. The blood supply of the femoral head is compromised, so that the femoral head is no longer viable. In older people and those with low functional demands only the femur can be replaced – partial hip replacement. In younger and active people the femur and the acetabulum are replaced – total hip replacement.
– Trochanteric: fractures below the neck of the femur (outside the joint). They are treated with bone fixation devices such as pins (inside the bone) or plate and screw systems (on the bone surface).
– Subtrochanteric: fractures between the small trochanter and 5 cm below it (outside the joint). They are treated, like trochanteric fractures, with bone fixation devices such as pins (inside the bone) or plate and screw systems (on the bone surface).
After surgical treatment it is important to start mobilization as soon as possible in order to avoid medical complications (disorientation, thrombus/clots, pneumonia or pressure ulcers). The total recovery time is very variable and depends on the patient’s general condition, type of fracture and treatment performed.
