FEMORAL NECK FRACTURE

By: Maree Josephine Noelle D. Navarro

DEFINITION
The femoral neck fracture is a crack near the
hip joint, located between the top (head) of
the bone of the leg and the main part of the
latter. The femoral neck fracture often occurs
in the elderly after a fall on the hip.
Osteoporosis (bone degradation) contributes
regularly to a broken bone. In severe
osteoporosis, a simple bad movement may
be enough to break a hip.


Younger patients suffer from a femoral neck
fracture most often after a violent shock, such
as during a car accident or skis to cause this
injury, the pressure on a young leg must be
extremely violent. A femoral neck fracture
requires an operation in the hours following
the accident, to prevent necrosis of the
femoral head (degradation and death of part
or the entire top of the femur).

SIGNS AND SYMPTOMS
Inability movements immediate and complete
Extreme pain in the hip area, the leg can not be
waived.
Increasing pain to the touch; optionally a swelling on
the side of the hip.
According to the fracture zone, the leg may be
shortened and turned to the side.
In rarer cases, the leg can not be turned to the side and
the pain may occur in the knee area; fracture risk of
femoral neck and at first not to be suspected.
Injury of blood vessels and nerves tends to occur in
young patients, that is to say, after a violent collision.

DIAGNOSTIC EXAM
Diagnostic confirmation using radiography (X-
rays) of the basin
Possibly a scanner (CT Computer Tomography)
Eventually an MRI (Magnetic Resonance
Imaging), primarily to exclude other injuries in
the hip area

CT SCAN MRI
PATHOPHYSIOLOGY
Following a fall or due to a direct blow to the
hip or thigh, stress is placed on the femur. If
these forces are excessive and beyond what
the femur can withstand, a break in the neck
of the bone may occur. When this occurs the
condition is known as a femoral neck fracture
and can vary from a small misplaced fracture
to a severe displaced (and / or comminuted)
fracture with obvious deformity.

TREATMENT AND MANAGEMENT
It is rare for a femoral neck fracture to be stable
enough to perform a conservative treatment
(without surgery). An operation is necessary in
most cases.

Conservative treatment (no surgery)
Bed rest for 10-14 days
Stabilization of the leg
Prevention (prophylaxis) of thrombosis
Possibly a respiratory therapy
After 2 or 3 days begin rehabilitation, first
cautiously, then with a gradual increase of the
load on the leg for 4 weeks.

Medical Drugs
Prevention of thrombosis
Optionally antibiotics in prevention of
infection
Pain

Types of surgery
The selected type of operation depends on
the overall health of the bone density and
location of the fracture. In all cases, the
operation should take place within 6 hours
after the accident (risk of necrosis of the
femoral head).

Insertion of a screw (Osteosynthesis) is only
possible at a density sufficient bone (not
osteoporosis).
Advantage : fast operation, low damage to
surrounding areas, the natural joint of the leg
(femoral head) remains in place.
Disadvantage : there is the risk of a mismatch of
the fracture and the formation of a false joint
(pseudoarthrosis). After this operation, the leg can
not bear immediately on body weight.

Dynamic hip screw (metal plates and screws) : to
stabilize, a metal plate is fixed to the upper leg
and a thick is placed on the screw head of the
femur. This operation is also possible that if the
bone density is sufficient.
Advantage: quick operation, the natural joint of the
hip (femoral head) remains in place.

Disadvantage: a shift of the fracture may occur. A
complete application of body weight is not
immediately possible. There is also a risk of necrosis
of the femoral head.

Artificial joint (prosthesis) of the hip : this
type of operation is performed in elderly
patients and with low bone density
(osteoporosis). There are two possibilities:
either a prosthetic femoral head is added to
the main part of the leg bone (femur), which
then slides into the hollow of the original hip
joint, or the artificial joint complete the
femoral head and the hollow of the hip, that is
to say a total hip replacement (PT) is added.

Advantage : the leg can support the weight of the
body shortly after surgery. Rapid recovery of the
patient avoids prolonged bed rest and reduces the
risk of complications (pneumonia, pulmonary
embolism, pressure sores).
Disadvantage : bigger deal, big damage to
surrounding areas. The hip prosthesis can
deteriorate, requiring a new operation for the
change.

NURSING CARE
Pain: the nurse must assess the degree of pain
the patient is in and administer prescribed
analgesics. To keep the patient free of pain,
move him/her for pressure area care and
prevent other complications of immobility.
Altered body function due to shock: the nurse
must observe the blood pressure and pulse
and report any change.

Loss of mobility and confidence: a suitable
type of walking and should be chosen.

Activities of daily living: assist the patient
when required to perform tasks related to
daily living. (ex. Personal hygiene, eating and
drinking, elimination )