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Femoral Neck Fracture

The femur is the largest bone in your body, extending from the hip joint to the knee joint. The top part of the femur, called the femoral head, has a rounded ball shape that fits into a socket in the pelvis to form the “ball-and-socket” hip joint. The long part of your femur bone, which spans your upper leg, is called the femoral shaft. The femur bone also has a short, narrower section that connects the femoral head to the femoral shaft, called the femoral neck. This part of the femur can break (fracture) either due to repetitive stresses or from a collision injury on the field. Either way, femoral neck fractures require prompt medical attention.

Femoral Neck Fracture Hero Image 2

The femur is the largest bone in your body, extending from the hip joint to the knee joint. The top part of the femur, called the femoral head, has a rounded ball shape that fits into a socket in the pelvis to form the “ball-and-socket” hip joint. The long part of your femur bone, which spans your upper leg, is called the femoral shaft. The femur bone also has a short, narrower section that connects the femoral head to the femoral shaft, called the femoral neck. This part of the femur can break (fracture) either due to repetitive stresses or from a collision injury on the field. Either way, femoral neck fractures require prompt medical attention. If a femoral neck fracture is left untreated, an interruption of blood flow to the femoral head can occur (called avascular necrosis). This can cause severe, lasting disability and even lead to the need for a total hip replacement.

Femoral neck fractures are classified into four grades of severity using the “Garden” system:

• Garden I: Partial fracture in which the femoral neck hasn’t been broken through completely.
• Garden II: Complete fracture in which the bone hasn’t moved out of place, called a nondisplaced fracture.
• Garden III: Complete fracture in which the broken ends of the bone have moved out of place but only only partially, considered a slightly to moderately displaced fracture.
• Garden IV: Complete fracture in which the broken ends of the bone have moved substantially and don’t line up, called a severely displaced fracture.

Displaced fractures (Garden III and Garden IV) are most common with acute injuries. In the early stages, stress fractures of the femoral neck are usually nondisplaced (Garden I or Garden II). However, without appropriate care, these fractures can become displaced over time.

What causes Femoral Neck Fracture?

Femoral neck fractures in athletes can occur either as stress fractures (due to repetitive weight bearing on the bone) or as traumatic fractures (from a severe collision on the field). Most common in long distance runners, stress fractures of the femoral neck start out as tiny cracks that extend with continued loading on the bone over time. Traumatic femoral neck fractures typically happen as a result of a collision, or fall, in contact sports.

Stress fractures of the femoral neck are most common in these sports:

• Long distance running
• Soccer
• Football training season
• Lacrosse

Traumatic fractures of the femoral neck can occur most commonly in these sports:

• Soccer
• Hockey
• Rugby
• Football

Symptoms

Athletes who have an acute injury that causes a femoral neck fracture will feel immediate and often severe groin pain at the time of injury, followed by inability to bear weight on the side of the injury. With a femoral neck stress fracture, symptoms usually begin gradually and then may increase over time. In general, symptoms of a femoral neck fracture include:

• Groin pain
• Pain at the front of the thigh
• Pain when rotating the hip
• Inability to put weight on the injured side

When to see a doctor

If you experience a severe injury on the field and can’t bear weight on your hip, prompt medical attention is necessary. Don’t attempt to walk or put weight on the injured side. You will need assistance getting to a medical facility.

If you have insidious and progressive groin pain and pain with weight bearing on one side, make an appointment to see your doctor right away, so that he/she can determine whether you may have a femoral neck stress fracture. Because femoral neck fractures can cause a loss of blood flow to the femoral head, or avascular necrosis, early evaluation and treatment are essential.

Your doctor will ask you about your symptoms and examine your hip. He/she will have you try to put your weight on the injured side, as well as rotate your leg to get a sense of your range of motion and where you feel pain. In order to make a diagnosis, your doctor will order an x-ray of your hip. If you have a femoral neck fracture, it will usually come up on an x-ray. If your doctor suspects a femoral neck fracture but doesn’t see it on the x-ray, he/she may follow up with a magnetic resonance imaging (MRI) scan. This test is able to pick up early stress fractures or small, incomplete traumatic fractures. The x-ray will also help your doctor determine the grade of the injury, which will then guide treatment.

Non-operative treatment

Some stress fractures of the femoral neck can be managed non-surgically. This may be the case for a stress fracture that is incomplete and/or nondisplaced, and is detected early. Non-operative treatment focuses on reducing weight bearing on the hip that is fractured. Treatment may involve:

• Using crutches to take weight off your injured hip
• Medication to alleviate pain
• Prescription blood thinners to prevent blood clots in the pelvis or legs (mostly for traumatic femoral neck fractures)
• Physical therapy

Surgical Treatment

Displaced femoral neck fractures, as well as some nondisplaced femoral neck fractures, require surgical treatment by an orthopedic surgeon. Depending on the severity of the fracture and the degree of bone displacement, your doctor will recommend one of several possible surgical procedures, performed under anesthesia:

• Closed reduction and internal fixation (CRIF) – The surgeon first manipulates the broken ends of the femoral neck into place without making an incision. Next, he/she uses a minimally invasive procedure to insert special screws (called cannulated screws) into the femoral neck to hold the bone together, allowing it to heal.
• Open reduction and internal fixation (ORIF) – This open surgical procedure is used to move the bones back into place and then insert cannulated screws into the femoral neck to hold the bone together, allowing it to heal.
• For some severely displaced (usually traumatic) femoral neck fractures, a partial hip replacement (hemiarthroplasty) may be necessary. In this case, a prosthetic device is used to replace only the femoral head and neck.
• For many severely displaced (usually traumatic) femoral neck fractures, a total hip replacement (THR, or arthroplasty) may be the best solution. In this case, prosthetic material is used to replace the upper section of the femur bone, the femoral head and neck, as well as the hip socket that the prosthetic femoral head fits into. THR may also be recommended if avascular necrosis occurs as a result of a femoral neck fracture.

Recovery

Recovery time after a femoral neck fracture depends on the severity of the fracture, the amount of displacement, and the type of surgery performed. If you had a CRIF or ORIF surgery with cannulated screws, you will need to use crutches or a walker and apply limited weight on the affected leg for the first few weeks after surgery. You may also need help with some activities, like climbing stairs. If prosthetic materials were used for partial or total hip replacement, you will most likely be able to put weight on your hip right away, with some support.

Depending on the procedure performed, returning to regular daily activities may take between one and four months after surgery. During this time, you should have regular and frequent follow-up visits with your orthopedic surgeon. Physical therapy can be helpful for regaining your hip flexibility, range of motion, strength, and endurance. Athletes with healed stress fractures of the femoral neck will be able to return to their sport, occasionally with some modifications or adjustments to avoid recurrent injuries. Those with traumatic femoral neck fractures that are treated surgically will need clear guidance from their surgeon before attempting to get back into play.

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