Femoral Neck Fracture

A common injury that mainly affects the elderly is a Femoral Neck Fracture, which is frequently caused by low-energy trauma like a fall from a standing height. This fracture occurs at the point where the femoral head and bone shaft converge, in the proximal portion of the femur.

An aging population and increased longevity are contributing to an increase in femur neck fractures globally.

Introduction:

Particularly in older adults, a broken hip, also known as a Femoral Neck Fracture, is a dangerous injury. It might alter someone’s life and possibly harm other people. Just below the ball and socket joint, it occurs when there is a break in the upper part of the femur, or leg bone.

An irregular walking pattern and a decrease in bone mineral density are the main causes of neck of femur fractures ,which are more common in elderly patients. The most affected patient is an elderly female osteoporotic patient.

The most common type of hip fractures are femoral neck fractures. The hip, a ball and socket joint, joins your upper leg to your pelvis. The femoral head is located in the femur, or upper leg bone, of an individual. the femoral neck is situated immediately below the femoral head. The femoral neck fractures that are intracapsular. The capsule contains the fluid that coats and lubricates the hip joint.

The treatment plan for an elderly patient with a displaced femur fracture will change based on these factors, including the location of the break and the quality of the blood supply.

Anatomy:

There is a ball and socket joint in your hip. The upper portion of the thighbone, or the head of the femur, is the ball. The term “acetabulum” relates to the socket. Part of the pelvic bone is the acetabulum. Its rounded form fits the femoral head well.

Hip capsule

The acetabular margin and transverse acetabular ligament are where the hip capsule is attached proximally. The greater and lesser trochanter bases, the trochanter’s intertrochanteric line, and the distally placed femoral neck are all positioned posteriorly and are 1/2 inch from the trochanter’s crest. Retinal vessels are found there, and they are important for blood flow to the femoral head.

Blood flow to the femur’s head

• The primary blood supply is through the retinal vessels. is the product of an extra-capsular arterial ring that is reinforced by the superior and inferior gluteal arteries of the internal iliac arteries and supplied by the medial and lateral circumflex vessels ( profundas femoris A).

• The foveal artery is not a major source of information. gives the layer of epiphysis a tiny amount of blood while the skeleton is growing. In adulthood, ligamentum the teres is believed to completely disappear.

• A minor source are the metaphyseal vessels. After skeletal maturity, blood is supplied to the femoral head via metaphysical arteries.

Etiology:

Low energy falls in the elderly have been associated to femoral neck fractures. A high-energy trauma, like falling from a great height or being in an automobile accident, is typically the secondary cause of femoral neck fractures in younger patients. The following factors increase the risk of femoral neck fractures: low bone density, limited mobility, and feminine gender.

Pathophysiology:

The medial femoral circumflex artery, which passes under the quadriceps femoris, is the main vascular supply to the femoral head. A displaced femoral neck fracture can cause severe bleeding, typically rupturing the upward cervical branches that originate from the circumflex arteries’ arterial ring supply. Inevitably, this could impair the fracture’s capacity to mend, leading to non-union or osteonecrosis. In The significance of this lies in the fact that arthroplasty is not suitable for the younger population that suffers from this fracture. In Avascular necrosis is the most frequent consequence among patients receiving open reduction internal fixation treatment.

Causes of Femoral Neck Fracture:

Hip fractures, usually as a result of falls, are most common in people 65 years of age and older. Even from little falls, as you age, your bones naturally weaken and fracture. Bicycle accidents, car accidents, and sports-related injuries are the main causes of hip fractures in children and young adults.

Some additional things that can break your hip are;

• Having a gender given to women from birth.
• You do not consume enough calcium and vitamin D to maintain strong bones.
• The history of smoking.
• It can be challenging to move safely and steadily if you have arthritis or other conditions that impair balance or dizziness.
• Using specific medications, like long-term COPD or steroid medications for asthma.

Femoral Neck Fracture Symptoms:

The symptoms of a hip fracture often appear suddenly. But they could start out mildly and get worse with time.

A hip fracture can cause the following symptoms;

• Limited mobility: Most hip fracture victims are unable to stand or move their legs. It might be possible to walk occasionally, but walking on one leg hurts so much.

• Hip pain: Usually very sharp and intense. But it can also feel achy or light. Most complain of pain in the groin, pelvis, outer hip, and thighs. Sciatica can cause discomfort in your legs that radiates from your buttocks. Knee pain is another possibility.

• Changes to your body: You may have a bruised hip. One leg may be shorter than the other in your situation.

Femoral Neck Fracture Risk Factors:

• Gender and Age

As people age, their muscle mass and bone density typically decrease. Seniors who have vision and balance issues are also inclined to falls. Women are affected by hip fractures approximately three times more frequently than men. Women lose bone density more quickly than men do due to menopause’s reduction of estrogen levels, which speeds up bone loss. But men can also have dangerously low bone density.

• The lifestyle Decisions

Weakened bones and muscles from not getting regular weight-bearing activity, like walking, increase the risk of fractures and falls. Use of alcohol and tobacco products can disrupt the natural processes that produce and maintain bone, leading to the loss of bone.

• Health Issues

Osteoporosis. Bones weakened by this syndrome are more prone to break.

• Thyroid problems

Thyroid hyperactivity may result in bone weakness.

• Intestinal disorders.

Conditions that restrict the absorption of calcium and vitamin D can also lead to weaker bones.

Diagnostic Differentiation:

• Hip dislocation

Dislocation of the hip joint occurs when the femoral head moves out of the acetabulum.

• Intertrochanteric fracture

This type of fracture happens when the fracture line is more distal, between the greater and lesser trochanters.

• Subtrochanteric fracture

Fracture of the femur: the femoral diaphysis contains the fracture line.

• Femur fracture

Within the femoral diaphysis is where the fracture line occurs in a femur break.

• Osteoarthritis

More severe pain. Most frequently, patients report having groin pain. soreness that gets worse when you move or go up stairs

Diagnosis:

Physical Evaluation

Your hip and pelvis are examined by a physician to determine the extent of swelling, bruises, and pain. they inquires as to the location and severity of your injuries. It is known as an open fracture when a bone breaks through the skin. This kind of fracture, which frequently needs for quick surgery, will be quickly identified by your doctor.

CT Tests

In order to determine the extent of the hip joint injury or to investigate a possible fracture pattern, your doctor might advise a CT scan. A CT scan uses X-rays and a computer to produce two- and three-dimensional images of the hip and pelvic bones, allowing doctors to view a fracture from a variety of perspectives. Small bone fragments that need to be surgically removed if they become lodged in the hip joint may also be found during this examination. Medical professionals use CT scans to make sure that repaired bones fit correctly.

Radiography

X-ray radiography pictures Utilize electromagnetic radiation to locate fractured bones in the hip or pelvis. They can assist your doctor in determining whether a bone has multiple fractures or has just been moved following a break.

• As the inferior border of the superior pubic ramus and the medial edge of the femoral neck are typically a continuous line, Shenton’s line rupture is defined as the loss of contour between these two areas.
• The lesser trochanter is more visible due to the femur’s external rotation.
• The unopposed iliopsoas often results in the femur being positioned in flexion and external rotation.
• Lateral femoral neck/head asymmetries
• Sclerosis in the plane of fractures
• Nondisplaced fractures may appear minor on an x-ray.
• Examining the AP pelvis and the lateral hip is crucial because pelvic fractures can mimic the clinical signs of hip fractures.
• Examine for symmetry, being particularly aware of the lesser trochanter, which may indicate external rotation.

MRI Images

Your doctor may advise an MRI if your symptoms point to additional damage to your blood vessels, ligaments, tendons, or nerves, or if they think that an X-ray would not recognize to having a stress fracture in your hip or pelvis. This test generates digitalized, three-dimensional images of the soft tissues surrounding the joint using radio waves and a magnetic field.

A bone fragment pressing against a nerve or torn or damaged ligaments or tendons could be seen on an MRI. If your symptoms point to a fracture but an X-ray shows no signs of trauma, doctors may also order an MRI.

A bone fragment pressing against a nerve or torn or damaged ligaments or tendons could be seen on an MRI. If your symptoms point to a fracture but an X-ray shows no signs of trauma, doctors may also order an MRI.

Treatment:

Reducing hip pain’s symptoms is the goal of conservative measures. Oftentimes, the functional result is not significantly different from surgical treatment. The fractured hip will require surgical treatment in the majority of other cases. Surgery is typically advised by medical professionals for an elderly patient who is functionally healthy in order to hasten healing and rehabilitation. Treatment for hip fractures usually consists of surgery, medication, and post-operative therapy.

Medical Treatment:

A maximum of ten percent of people 65 years or older will experience another hip fracture within two years of their first hip fracture. Medication for osteoporosis, like bisphosphonates, can reduce the risk of recurrent hip fractures. In order to avoid side effects that might make oral bisphosphonates difficult to tolerate, your doctor might suggest intravenous (IV) tube delivery.

Patients with kidney problems are typically not advised to take bisphosphonates. Extremely rare side effects from long-term bisphosphonate therapy include abnormal hip fractures, visual problems, and jaw pain and swelling.

Non-Surgical Treatment:

For a hip fracture, surgery isn’t always required. You won’t need surgery if you had a fracture in the past and only visited your doctor once the bone began to heal. Still, ignoring a hip fracture is not a good idea. It might result in a serious, long-term impairment.

Moreover, some patients might decide against having surgery. That is the purpose of conservative therapy. These consist of particular practices and tools which are helpful in reducing discomfort and preventing additional harm.

Physiotherapy Treatment:

Our doctor might advise you to see a physiotherapist prior to and following surgery. Exercise promotes the healing process by supplying oxygenated blood and nutrients to your broken bone.

Sometimes physiotherapist and doctor will approve of weight-bearing exercises combined with bed rest. The fundamentals of stretching and range-of-motion exercises can be obtained from your physiotherapist.

There are three advantages to physiotherapy. Your muscles don’t initially become weaker because of it. It also makes you more flexible. Lastly, it increases your range of motion. The length and frequency of your physiotherapy sessions will be determined by your condition. A trip to the physiotherapist can maintain your muscles strong and help in the healing of your hip fracture.

Surgical Treatment:

The thigh bone and femur, which together make up your hip joint, are housed in a socket in your hip bone. There are three potential fracture sites, with the femur being the most frequent. Different kinds of fractures can be treated surgically using a variety of techniques.

An intracapsular fracture happens close to the femur’s neck or ball. Another name for this condition is a femur neck fracture.

Surgical options include;

• Internal fixation

Your surgeon will use metal plates that run down your femur, screws, and pins to hold your fractured femur together while it heals if you have a displaced femoral neck fracture.

• Replacement of the hip

Unlike a hemiarthroplasty, a total hip replacement, or arthroplasty, includes the hip socket. Your hip is rebuilt by your surgeon using a prosthetic socket that is welded into the bone. Following injury, the damaged femoral ball is swapped out for a metal or ceramic one that fits the prosthetic socket.

Rehabilitation:

You will probably be getting out of bed and moving around on the first day after surgery, according to the doctors who treated you. Physiotherapy will initially concentrate on exercises that improve range of motion and strength. Depending on the type of surgery you had and whether you have help at home, you may need to move from the hospital to an extended care facility.

In order to develop the skills necessary for independence with daily tasks like dressing, cooking, taking a shower, and using the toilet, you may work with an occupational therapist at home or in an extended care facility. Your therapist will determine if getting around in a wheelchair or using a walker can help you regain your freedom and mobility.

Prevention:

• Eating healthfully: Calcium and vitamin D-rich diets help build stronger bones.

• Having regular examinations: Inquire with your doctor about bone density testing to identify osteoporosis early on. Bisphosphonates are medication that strengthen and lessen bone loss; your doctor might suggest them.

• Preventing accidents: Remove any throw rugs or other objects that could cause falls from your house. When using the stairs or going across frozen surfaces, exercise caution. Discuss with your physician how to take care of your body and prevent falls if you have Parkinson’s disease.

• Preserving your health: Reduce alcohol intake, keep your weight in check, and stop smoking.

Summary:

Common injuries to the proximal femur, femoral neck fractures are linked to a higher risk of avascular necrosis as well as high rates of disability and mortality in the patients. Parallel radiographs of the hip are typically used to make the radiographic diagnosis. Internal fixation, as opposed to arthroplasty, is typically used in conjunction with open reduction depending on the patient’s age, pre-injury activity level, and mobility.

FAQ:

Reference:

• On December 11, 2018, Santos-Longhurst, A. Overview of the Hip Femoral Neck Fracture. Wellline. Femoral neck fracture: https://www.healthline.com/health/

• Varacallo, M., Tiwari, V., and Hayat, Z. (2024, May 1). Femoral neck fractures: Surgical Management. https://www.ncbi.nlm.nih.gov/books/NBK538236/ StatPearls – NCBI Bookshelf.

• Gaillard, F., and D. MacManus (2008) May 2. fracture of the femur neck. Radiopaedia.in. 1.053347/rid-1926 can be found here.

• Biomechanics of Femoral Neck Fractures, n.d. Physiopedia Femoral Neck Fractures and Biomechanics: https://www.physio-pedia.com

• January 16, 2024, Admin. Anatomy And Pathology Of The Hip Joint | London Bridge Sports Med. London Bridge Sports Medicine. the anatomy and pathology of the hip joint at https://lbsm.co.uk

• Image 1, Sorts. (September 11, 2017). Stanford Medical Center. Hip fractures can have a variety of causes, according to Stanford Health Care’s website under Medical Conditions.

• Image 2, (2024, January 16). Admin. London Bridge Sports Medicine – Hip Joint Anatomy and Pathology. Sports Medicine London Bridge. Hip joint anatomy and pathology: https://lbsm.co.uk/