A femur neck fracture is a serious injury involving a break in the upper part of the thigh bone, where the ball of the hip joint connects to the main shaft. This hip fracture can significantly impact mobility and overall health, particularly in older adults. Prompt medical attention is required.
Understanding Femur Neck Fractures
The hip joint is a ball-and-socket joint where the rounded head of the femur (thigh bone) fits into the acetabulum (hip socket). The femoral neck is the narrower bone segment just beneath the femoral head. A fracture here can partially or completely detach the femoral head from the femur.
Femur neck fractures are categorized by displacement: displaced (bone fragments out of alignment) or non-displaced (bone broken but in proper position). They are also classified as subcapital (head-neck junction), transcervical (mid-neck), or basicervical (base of neck). Displaced fractures can disrupt the blood supply to the femoral head.
Common Causes and Risk Factors
Femur neck fractures often result from low-energy trauma, such as a minor fall or twisting injury, especially in older individuals. High-energy trauma, like motor vehicle accidents or falls from heights, causes them more often in younger individuals.
Several factors increase susceptibility. Osteoporosis, which weakens bones, is a major risk factor, especially in the elderly. Over 90% of these fractures occur in individuals over 50, with women more frequently affected. Other conditions include neurological disorders, low body weight, poor nutrition, inactivity, or sudden increases in strenuous activity.
Recognizing the Symptoms
A femur neck fracture causes immediate, severe pain in the hip or groin. This pain intensifies when bearing weight on the affected leg or rotating the hip.
The injured leg may appear shorter and externally rotated, with the foot and knee turning outward. Swelling on the hip side may also be observed. Immediate medical attention is recommended if these symptoms are present.
Treatment and Rehabilitation
Treatment for a femur neck fracture typically involves surgical intervention, as non-surgical management is rarely stable enough to ensure proper healing. The specific surgical approach depends on factors such as the patient’s age, the extent of the fracture’s displacement, and their overall health. For non-displaced fractures, internal fixation with screws or a sliding hip screw may be used to stabilize the bone. This involves placing multiple screws across the fracture to hold the bone fragments together.
In cases of displaced fractures, where the blood supply to the femoral head may be compromised, joint replacement procedures are often preferred. A hemiarthroplasty, or partial hip replacement, involves removing the fractured femoral head and replacing it with a metal implant, while the hip socket remains intact. For elderly, active patients without significant medical conditions, or those with pre-existing arthritis, a total hip replacement (THA) may be performed, replacing both the femoral head and the hip socket with artificial components.
Following surgery, rehabilitation is a rigorous and individualized process focused on restoring mobility, strength, and independence. Physical therapy typically begins within 24 to 48 hours post-surgery, with gentle range-of-motion exercises and assisted walking using a walker or crutches. Over several weeks, therapy progresses to include muscle-strengthening exercises, balance training, and gait retraining to mitigate complications like stiffness and muscle atrophy.
Patients are advised to adhere to weight-bearing restrictions as instructed by their surgeon, with partial weight-bearing often recommended for 8 to 10 weeks after internal fixation, and full weight-bearing after approximately three months, depending on healing. Recovery can span several months, typically ranging from 4 to 6 months, and includes pain management, often with a combination of injections and oral medications. Occupational therapy may also be recommended to help patients regain daily living skills.
Preventing Future Fractures
Preventing future femur neck fractures largely centers on reducing the risk of falls and improving bone health. Home safety modifications are a straightforward approach; these include removing tripping hazards such as loose rugs and cords, ensuring adequate lighting, and installing grab bars in bathrooms and handrails on staircases. Wearing well-fitting shoes can also help prevent falls.
Engaging in regular physical activity, particularly exercises that enhance strength and balance like Tai Chi, can significantly reduce fall risk by 20% to 30%. Optimizing bone health involves adequate intake of calcium and Vitamin D, with recommended daily allowances of calcium ranging from 1,000 to 1,200 mg and Vitamin D from 600 to 800 IU, depending on age. Regular medical check-ups are also important to screen for osteoporosis and to review medications that might cause dizziness or drowsiness, further contributing to fall prevention.