Femoral Neck Fracture Causes, Symptoms & Treatment Options

Overview

The femur extends from the hip joint to the knee joint and plays a major role in standing, walking, and athletic movements. The top of the femur includes the femoral head, which fits into the pelvis to form the hip joint. Just below this is the femoral neck, a thinner section that absorbs large amounts of force with every step. Because of this stress, the femoral neck is vulnerable to injuries such as a fractured femur from trauma or a femoral neck stress fracture from overuse.

Femoral neck fractures are classified using the Garden system:

• Garden I: Partial fracture, not fully broken.
• Garden II: Complete fracture without bone displacement (nondisplaced).
• Garden III: Complete fracture with partial displacement.
• Garden IV: Complete fracture with severe displacement and bone misalignment.

Stress fractures usually begin as Garden I or II injuries but can progress to Garden III or IV if not treated early.

What causes Femoral Neck Fracture?

A femoral neck fracture can occur from two primary causes: overuse and trauma. Stress-related fractures develop from repetitive loading of the bone over time, such as long-distance running or high-impact training without adequate rest. These fractures begin as tiny cracks that worsen with continued strain. Traumatic fractures happen suddenly from intense force, such as collisions, falls, or direct blows in contact sports. Both types of injuries can result in a fractured femur, and both require immediate medical evaluation.

How the Injury Occurs

A traumatic femur fracture in the neck region usually occurs when the hip absorbs a sudden, powerful impact. This can happen during a fall, a direct collision with another player, or an unexpected twist during play. With stress fractures, the injury progresses gradually. Repetitive force on the hip, especially in activities that involve long distances, frequent jumping, or rapid acceleration, creates small cracks that eventually form a complete femoral neck stress fracture if not addressed early.

Common Everyday Causes

Although athletes are highly susceptible, non-sporting activities can also lead to a femoral neck  fracture. Slipping on stairs, landing awkwardly after a misstep, or experiencing a sudden jolt can place excessive pressure on the femoral neck. Poor bone strength, low vitamin D levels, and inadequate rest between workouts can also increase the risk of a femoral neck fracture in active individuals.

Sports With the Highest Risk of Femoral Neck Stress Fractures

Stress-Related Femoral Neck Fractures

• Long-distance running: Repetitive impact and high mileage put continuous strain on the femoral neck.
• Soccer: Constant sprinting and direction changes increase repetitive stress.
• Football training: Intense preseason conditioning often overloads the femur.
• Lacrosse: Quick pivots and long runs place consistent pressure on the hip.

Traumatic Femoral Neck Fractures

• Soccer: Player collisions or falls may cause sudden hip impact.
• Hockey: High-speed contact and falls are common injury sources.
• Rugby: Tackles place strong forces on the hip and thigh.
  
• Football: Hard hits and awkward landings can cause acute fractures.

Symptoms

A traumatic femur fracture in the femoral neck causes immediate, sharp groin pain and an inability to bear weight. In contrast, a femoral neck stress fracture develops gradually, with symptoms that increase over days or weeks. 

Common signs include:

• Groin pain that worsens with movement
• Pain in the front of the thigh
• Pain when rotating or turning the hip
• Difficulty or inability to bear weight on the injured leg

These symptoms should never be ignored, as untreated fractures can worsen quickly and lead to serious complications.

Non-operative treatment

Some femoral neck stress fractures can be treated without surgery, especially if the bone is not displaced. Non-operative care focuses on reducing stress on the injured hip and allowing the bone to heal. Treatment may include:

• Crutches: To avoid putting weight on the injured side.
• Pain-relief medication: To ease discomfort during recovery.
• Blood thinners: Often recommended after traumatic femur injuries to prevent clots.
• Physical therapy: To restore strength, mobility, and hip stability once healing begins.

This approach is reserved for early-stage, nondisplaced fractures that are closely monitored by a physician.

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Femoral Neck Fracture

Surgical Treatment

Most displaced femoral neck fractures and some nondisplaced fractures require surgery. Treatment options depend on bone alignment, the severity of the fracture, and the patient’s age and activity level.

Common surgical options(open reduction  include:

• Open Reduction and Internal Fixation(ORIF)

The surgeon realigns the bone without making a large incision, then uses cannulated screws to stabilize the fractured femur For more severe fractures, this open procedure repositions broken bone fragments and secures them with screws or plates.

• Partial Hip Replacement (Hemiarthroplasty)

A prosthetic device replaces the femoral head and neck when the fracture is severely displaced or the bone cannot be repaired.

• Total Hip Replacement (THR)

Both the femoral head/neck and the hip socket are replaced. This is often required for Garden IV fractures or when avascular necrosis develops.