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femoral neck fractures are intracapsular, placing them at higher risk for nonunion than other hip fractures
because the femoral neck has a thin periosteum
and the fracture is bathed in synovial fluid,
and a relatively poor blood supply that can be disrupted by injury.
For these reasons, these fractures have a higher rate of nonunion and are more likely to lead to avascular necrosis of the femoral head.
The femoral neck can break in different areas:
directly below the femoral head (subcapital),
in the middle (transcervical)
or toward the side (basicervical).
In general, the more proximal the fracture line, the higher the risk for avascular necrosis.
classification.
The Garden classification scheme is based upon radiographic appearance and categorizes fractures into four stages.
Type I: fractures are considered incomplete fractures.
Type II: fractures are complete fractures without displacement.
Type III: fractures are complete fractures with partial displacement.
Type IV: fractures are complete fractures with full displacement of the shaft relative to the head.
The Pauwel classification also includes the inclination angle of the fracture line relative to the horizontal.
Type I less than 30 degrees.
Type II 30 to 50 degrees.
Type III greater than 50 degrees.
Higher angles and more vertical fractures exhibit greater instability and have a higher risk of osteonecrosis postoperatively.
the sudden onset of hip pain, either before or following a fall,
and the inability to walk,
although some patients with a minimally impacted fracture may continue to bear weight.
A displaced hip fracture usually involves a significant amount of groin pain and the leg may appear externally rotated and shortened.
With stress fractures, there may be no obvious history of trauma and the patient may complain of vague knee, buttock, groin, or thigh pain.
Patients with hip fracture are at high risk of venous thromboembolism.
Your doctor may also prescribe medications to prevent blood clots,
relieve pain and treat any infection that may be present.
Non-operative management for these fractures is rarely the treatment course.
It is only potentially useful for non-ambulatory, comfort care, or extremely high-risk patients.
Conservative treatment involves avoiding stress on the fracture,
typically, through consistent bed rest with the afflicted leg in a special position.
After some time of conservative healing, the leg can be mobilised with physiotherapy.
The goal of operative treatment is for the doctor to quickly stabilise the fracture and spare the often older patient long periods of complete immobility.
We perform hip fracture surgery within 24 hours of hospitalization for patients who are medically stable and without significant comorbid illness.
Whenever possible, surgery should not be delayed beyond 72 hours.
The type of surgery generally depends on where and how severe the fracture is,
whether the broken bones aren't properly aligned,
and your age and underlying health conditions.
Options include:
cannulated screw fixation.
we recommend this option when the fracture is not older than 24 hours.
The fracture is not displaced.
The patient has good bone quality and there are no signs of osteoporosis.
Young Patients (less than 60).
With more vertically oriented fractures such a Pauwel III,
basicervical fractures, a sliding hip screw is biomechanically stable.
Deep venous thrombosis prophylaxis should be started during the perioperative period and continued for 4 to 6 weeks postoperatively.
With the support of experienced physiotherapists,
patients will therefore already sit on the edge of the bed and be mobilized the first day after surgery.
post-operation partial weight bearing using crutches or walker for up to 6 weeks.
physiotherapy care and muscle strengthening exercises until full weight bearing after 6 weeks.
after approximately 5 months: easy sports such as swimming is permitted.
hip replacement.
in total hip replacement, the upper femur and the socket in the pelvic bone are replaced with artificial parts.
we perform the total hip replacement in in elderly patients older than 60 years.
In some situations, the socket part of the hip doesn't need to be replaced.
Partial hip replacement might be recommended for adults who have other health conditions or who no longer live independently.
With a hip replacement, the patient can already place weight on the leg the day after surgery.
It does not require a long period of bed rest.
Immediately following the hip replacement surgery, the patient starts physiotherapy exercises to regain mobility.
Prognosis.
The death rate within one year of fractured neck of femur is typically reported as between 20% and 30%.
with the highest risk within the first six months.