A displaced femoral neck fracture occurs when the bone connecting the ball of the hip joint to the main thigh bone breaks, and the broken pieces are no longer in their proper alignment. This displacement can disrupt the blood supply to the femoral head, the ball-shaped top of the thigh bone, impacting the bone’s ability to heal and potentially leading to complications.
Understanding the Injury
This type of fracture commonly results from falls, particularly in older adults whose bones may be weakened by conditions like osteoporosis. In younger individuals, displaced femoral neck fractures typically arise from high-energy trauma, such as car accidents or falls from significant heights. Regardless of the cause, recognizing the symptoms is important for timely medical attention.
Individuals experiencing a displaced femoral neck fracture often report severe pain in the hip or groin area. The pain can worsen when attempting to move the leg or bear weight. Other signs may include an inability to stand or walk, and a noticeable shortening or outward rotation of the affected leg.
Diagnosis and Treatment Approaches
Diagnosing a femoral neck fracture typically begins with imaging techniques. Initial assessment often involves X-rays of the hip and pelvis to identify the fracture and determine its extent. If X-rays are inconclusive or if subtle fractures are suspected, a computed tomography (CT) scan or magnetic resonance imaging (MRI) may be used for more detailed views, with MRI being particularly sensitive for assessing blood supply to the femoral head.
Displaced femoral neck fractures almost always require surgical intervention due to the significant risk of complications like poor healing or loss of blood supply if left untreated. Surgical goals include realigning the bone fragments and stabilizing the hip to promote proper healing and restore function.
Several surgical options exist, with the choice often depending on factors like the patient’s age, overall health, activity level, and the specific characteristics of the fracture. One approach is internal fixation, where screws, pins, or a plate are used to hold the fractured bone pieces together. This method is generally considered for younger, healthier patients with good bone quality, as it aims to preserve the patient’s own hip joint.
Another common treatment is hip replacement, known as arthroplasty. Hemiarthroplasty involves replacing only the ball (femoral head) of the hip joint with a prosthetic implant. This is a frequent choice for older patients with displaced fractures, especially when blood supply to the femoral head is compromised. Total hip arthroplasty (THA) replaces both the femoral head and the hip socket. THA may be considered for active elderly patients or those with pre-existing arthritis in the hip joint, as it can offer excellent functional outcomes.
The Recovery Process
Following surgery for a displaced femoral neck fracture, the immediate focus is on managing pain and beginning early mobilization. Patients are often encouraged to get out of bed and start moving with assistance within a day or two after the procedure. This early activity helps prevent complications such as blood clots and promotes circulation.
Physical therapy plays a crucial role throughout the recovery journey. A therapist guides patients through exercises designed to regain strength in the hip and leg muscles, improve flexibility, and restore range of motion in the hip joint. These exercises are tailored to the individual’s progress and the type of surgery performed.
Weight-bearing progression is carefully managed, varying based on the surgical method. Patients who undergo a hip replacement (hemiarthroplasty or total hip arthroplasty) are often allowed to bear weight as tolerated almost immediately after surgery. For those with internal fixation, a period of partial weight-bearing may be recommended for approximately 8 to 10 weeks before progressing to full weight-bearing, depending on fracture healing. Assistive devices like walkers, crutches, or canes are commonly used to support mobility during different stages of recovery.
The overall recovery timeline can vary significantly among individuals, influenced by age, general health, and commitment to rehabilitation. Many patients can expect to regain much of their pre-injury mobility within three to four months. However, full recovery, including a return to previous activity levels, may take up to a year.