- Femoral neck fractures occur between the femoral head and the pertrochanteric region (between the small and large trochanters). The head and neck of the femur have a complex vascular structure that determines the prognosis and therefore the treatment of these fractures varies according to the fracture trace and the spacing of the fracture tops.
- They correspond to 50% of the proximal femoral fractures; they occur in men at 72 years on average and in women at 77 years.
- Several studies confirm the exponential increase in the incidence of proximal femoral fractures with advancing age, with a marked increase from 65 years and for both sexes.
- Injury Mechanisms:
– Low-energy trauma – more frequent in the elderly – large trochanter impact
– High energy trauma – sick young and old – fall from height and traffic accidents
– Cyclic stress – most common in athletes, military recruits and ballerinas
Clinic (Signs and Symptoms)
- Impacted fractures and stress fractures may be non-deformed and the patient may be burdened and only describe mild pain.
- Uncapped fractures (dislocated): patients are unable to walk and have shortening and external rotation of the limb
Complementary Diagnostic Tests
- The radiographs of the pelvis and the proximal femur profile are usually sufficient to make the diagnosis. Sometimes a CT scan may be needed to clarify the fracture trace, or in cases where the radiograph is not sufficiently clear
- Non-surgical: Reserved only for patients with other illnesses with extreme medical risk and where surgery may endanger their lives. It may also be considered in demented patients who are unable to walk and who have little pain.
- Stress / fatigue fractures: Non-surgical treatment with discharge and decreased physical activity may be performed. Surgical treatment with internal stabilization should be considered if conservative treatment fails.
- Impacted, Uncoated Fractures: May be uncovered if not stabilized. There is also a risk of avascular necrosis due to the risk of alteration of femoral head vascularization due to fracture.
- Uncapped / Removed Fractures:
– Young patients – try to reduce and fix the fracture.
– Elderly patients: Usually a partial hip replacement (hemiarthroplasty in patients with low functional requirement) or total hip replacement is usually performed in less elderly patients, but still with a significant level of activity.
- It involves early mobilization, stand up and gait training. The aim is to rehabilitate the patient to the functional level prior to fracture.