Young Patients with Femoral Neck Fracture

Physical Therapy Videos - Hip and Pelvis

Basic Anatomy

A femoral neck fracture is a type of hip fracture, and is commonly called a broken hip. Your hip joint is made up of two bones: the thigh bone (femur) and the pelvis. Your hip joint is a ball-in-socket joint that allows you to bend at the top of your leg when walking. Hips that break between the ball and tip of the thigh bone have a femoral neck fracture (Figure 1).

Figure 1: A model of a hip and pelvis, and an x-ray showing the femoral neck.

Mechanism and Epidemiology

Femoral neck fractures in young patients typically happen due to a high-energy event such as a car accident, motorcycle accident, or a fall from height. Patients younger than 60 years of age with good bone quality are typically considered "young," since their hips break in a different way than older patients with weaker bone.

Figure 2: X-rays of a femoral neck fracture. The red arrows point to the break.

Initial Treatment

Femoral neck fractures are generally painful and will prevent you from walking. Any movement of your injured leg typically causes pain. When you break your hip, you are typically taken to an emergency room by ambulance. Once at the hospital you will get x-rays of your hip and perhaps the thigh bone. You may need a CT scan of your hip to provide more detail of your broken bone. Your doctor may or may not recommend traction. This is a way of gently pulling on your leg until you are able to go to the operating room, and is intended to decrease your pain. As you cannot walk until your injury is fixed and may need pain medication, you will need to be admitted to the hospital for care of this injury.

General Treatment

Femoral neck fractures generally require surgery. Since the blood supply to your hip may have been interrupted, one of the major concerns for this fracture is whether it will heal or not. There are several varieties of implants that may be used to treat a femoral neck fracture, depending on the patient and fracture characteristics.

Figure 3: X-ray of a hip with lines showing the blood supply to the femoral neck.

Figure 4: X-ray of a femoral neck fracture fixed with screws.

Figure 5: X-ray of a femoral neck fracture fixed with a sliding screw and plate and screws.

Figure 6: X-ray of a femoral neck fracture fixed with a hip replacement.

Post-operative Care

After surgery, you will work with physical therapy both in and out of the hospital to rebuild your strength and restore normal walking. Weight bearing status (how much weight can be placed on the injured extremity) depends on a number of factors and it is best to ask your surgeon. To prevent blood clots, you likely will be placed on a blood thinner. Blood thinners and early walking are important for preventing blood clots. Several types of pain medication are used for post-operative pain, with the goal to gradually work towards non-narcotic (non-opioid) pain medicine.
After a short stay, you will be discharged from the hospital. You may need to spend some time in a rehab facility or skilled nursing facility. You will typically return to see your surgeon in the first few weeks after surgery. It is very important that you follow the instructions given to you by your surgeon.

Following surgery, you may need an assistive device such as a walker or cane for at least a short period. Physical therapy is usually needed to help you get back to a normal walking motion, and the therapist will help you work on muscle strengthening, stretching, and endurance training. To make the recovery as fast as possible, it is important that you continue to do the exercises learned in therapy at home.

Long Term

Complications after femoral neck fracture are infrequent but can occur. These include blood clot, infection, difficulty walking, or a limp. Long-term risks include your bone not healing (nonunion) or not healing in the correct position (malunion), painful implants, and arthritis. Long-term complications of joint replacements include dislocation, fracture, and your legs being not equal in length. For some complications, further surgery may be necessary.