A basicervical femoral neck fracture is a break at the base of the femoral neck, the narrow section of bone connecting the femoral head to the main shaft of the thigh bone (femur). The fracture occurs where the femoral neck meets the broader part of the femur. It is a significant hip injury, impacting mobility and quality of life.
Causes and Diagnosis
Basicervical femoral neck fractures result from forces varying by age. Older adults commonly sustain these fractures from low-energy falls, such as slipping or tripping, especially when osteoporosis has weakened their bones. Osteoporosis reduces bone density, making bones fragile and susceptible to breaks from minimal trauma. For younger individuals, these fractures arise from high-energy trauma, such as motor vehicle accidents or falls from significant heights, where substantial force is applied to the hip.
Individuals typically experience severe hip or groin pain, worsening with movement. They are often unable to bear weight on the affected leg. The injured leg may appear shorter or be externally rotated, meaning it turns outward.
Diagnosis begins with a physical examination, carefully assessing symptoms and leg position. Imaging confirms the fracture’s location and severity. X-rays are the primary diagnostic tool, providing clear images of the bone and revealing the fracture line. CT scans or MRI may be ordered for more detailed views, to assess soft tissue damage, or identify subtle fractures not clearly visible on X-rays.
Surgical Treatment Approaches
Surgery is almost always necessary for basicervical femoral neck fractures due to biomechanical stresses on this region and complication risks. The surgical approach depends on factors like patient age, bone quality, activity level, and fracture displacement. The goal of surgery is to stabilize the fracture, alleviate pain, and restore the hip’s function.
Internal fixation is a common surgical approach, aiming to preserve the natural hip joint by holding broken bone fragments together. This involves a dynamic hip screw (DHS), a large screw inserted into the femoral head that slides within a plate fixed to the femoral shaft, allowing controlled compression across the fracture site. Another method uses multiple cannulated screws, hollow screws inserted across the fracture for stability. Internal fixation is preferred for younger patients with good bone quality and less displaced fractures, as it maintains original anatomy.
Alternatively, arthroplasty (hip replacement) may be performed, especially for older patients, those with significantly displaced fractures, or pre-existing hip arthritis. This procedure involves replacing part or all of the hip joint. Hemiarthroplasty replaces only the femoral head with a prosthetic implant. This simpler procedure allows quicker weight-bearing.
Total Hip Arthroplasty (THA) replaces both the femoral head and the acetabulum (the “socket” in the pelvis) with prosthetic components. THA is chosen for patients with pre-existing hip arthritis or highly comminuted fractures, offering a more durable solution and often allowing immediate weight-bearing. This approach leads to a lower risk of complications associated with fracture healing in older, more fragile bones.
The Recovery Journey
Recovery begins with an initial hospital stay, lasting a few days to a week. Pain management is a focus, often involving intravenous and oral medications for comfort. Early mobilization is encouraged, with physical therapists beginning gentle exercises and assistive device training (e.g., using a walker) within 24 to 48 hours post-procedure.
Patients will have weight-bearing restrictions on the affected leg, varying by surgical method and individual healing. Toe-touch weight bearing allows only light ground contact for balance. Partial weight bearing allows a prescribed amount of weight, often measured in percentages. Adhering to these restrictions is crucial for proper bone or implant healing.
Physical therapy continues for several weeks or months after discharge. These sessions focus on regaining the hip’s range of motion, strengthening the surrounding muscles, and improving balance and coordination. Patients gradually progress from using walking aids to walking independently as strength and stability improve. Returning to daily activities, such as dressing and light household chores, can take weeks to months. Fuller recovery, including resuming more strenuous activities, may extend to six months or a year.
Understanding Potential Complications
Despite successful surgical treatment, individuals recovering from a basicervical femoral neck fracture face several potential complications. One significant risk is avascular necrosis (AVN) of the femoral head. This occurs when the blood supply to the “ball” of the hip joint is disrupted by the fracture, leading to the death of bone tissue. If AVN develops, it can cause pain, collapse of the femoral head, and may necessitate further surgery, such as a hip replacement.
Another concern is nonunion, which means the broken bone fragments fail to heal together properly. This can occur if there is insufficient stability at the fracture site or if the blood supply is severely compromised. Malunion is a related complication where the fracture heals, but in an incorrect anatomical position, potentially leading to altered hip mechanics and pain. Both nonunion and malunion may require additional surgical intervention to correct the alignment or promote healing.
Beyond these fracture-specific issues, general surgical risks also exist. These include the possibility of infection at the surgical site, which might require antibiotics or further procedures. Blood clots, particularly deep vein thrombosis (DVT) in the legs, are also a concern due to reduced mobility after surgery. These clots can potentially travel to the lungs, a serious condition known as a pulmonary embolism.