Fractures of the neck of the femur

The term hip fracture actually corresponds to a fracture in the neck of the femur. These fractures can be extra-articular (peri-trochanteric fractures) or intra-articular ( in other words, the upper end of the femur which supports the head of the femur).

Types of proximal femur fractures

The head fits into the pelvis at the acetabulum to form the hip joint, or coxo-femoral joint.

As the name suggests, the neck of the femur corresponds to a narrowed and thus fragile area as it supports the entire weight of the trunk through the pelvis. In addition, the neck of the femur is vascularized by the circumflex artery, which is often injured when the fracture fragments move out of alignment.

Neck of femur blood supply

Eventually the arterial injury will compromise bone consolidation and could require hip replacement.

80% of femoral neck fractures occur after a fall in elderly patients with a history of osteoporosis.

Any hip pain after a fall should be considered a fracture of the femoral neck until proven otherwise.
The pain is sharp, localized at the level of the hip or groin area, and worsens with movement of the thigh.

Many patients can no longer stand or move the leg. The limb appears turned outwards and shortened.The proximal part of the thigh is deformed.

Leg shortening and external rotation of the fractured limb

Radiographic assessment:

A simple x-ray (AP and lateral views) of the hip can make the diagnosis and determine the most suitable surgical treatment

Treatment:

Ideally, surgical treatment (osteosynthesis) should be performed within 24 hours. The choice of technique depends on several parameters: the type of fracture (intra or extra articular), the degree of a displacement, the patient’s age (in young patients, preservation of the femoral head is preferred), general condition, the degree of existing osteoporosis, and the patient’s level of activity.

Surgical options :

• Hip prosthesis consists of replacing the head of the femur, also called a hemi-prosthesis.

Neck of femur fracture treated by hemi-arthroplasty

When the socket of the hip joint (acetabulum) is in poor condition, the surgeon may have to replace it with a synthetic cup, also called total hip prosthesis. The prosthesis allows early weight bearing and faster recovery. It is particularly indicated in elderly patients when adequate repair of the fracture is not possible.

• Osteosynthesis (placement of screws, nail or plate) is preferred in younger patients or in elderly when possible.

Neck of femur fracture treated by osteosynthesis

Regardless of the treatment option decided upon, rehabilitation must be started as soon as possible.