Geriatric Femoral Neck Fractures (Broken Hip in Older Patients)

Physical Therapy Videos - Hip and Pelvis

Basic Anatomy

The human hip joint is a ball and socket joint. The top portion of the femur (thigh bone) is known as the femoral head, and joins with the acetabulum (hip socket). The femoral neck is the portion of the thigh bone that joins the femoral head to the femoral shaft (long portion of the thigh bone). Due to its location, a significant amount of force is transmitted across the femoral neck.

There are large muscles around the hip joint. The muscles in front are known as the quadriceps. The muscles in the back of the hip are the buttock muscles. These big muscle groups along with others help you move your leg.

The blood vessels to the hip and leg come mainly from the front of your leg near your groin. There are some smaller blood vessels that come along the back. The nerves to the hip as well as the leg muscles come from both the front and the back of the hip.

The image on the left is an x-ray of an adult hip, on the right the femoral neck — Figure 1: The image on the left is an x-ray of an adult hip. In the image on the right, the femoral neck (red), femoral head (yellow) and hip socket (blue) are outlined.

Figure 2: A model of the pelvis and hips.

Mechanism and Epidemiology

Fractures (breaks) of the femoral neck are common in individuals over the age of 65 years. As you age your bone quality and density declines. This can make the bones susceptible to fracture. These injuries typically occur after a fall from a standing height. People typically fall directly onto their hip. These fractures can also occur from other mechanisms such as motor vehicle collisions or from jumping down off a ladder or a step.

Figure 3: X-rays of a displaced femoral neck fracture.

Initial Treatment

Femoral neck fractures are generally painful and will hurt enough to keep you from being able to walk after you hurt yourself. Any movement of your injured leg will typically make it hurt. Patients with these fractures are taken to the emergency room, usually by ambulance, to be evaluated. Once in the emergency room, x-rays help doctors see the broken bone. Medication is generally given for pain relief. Most broken hips need surgery and most patients with hip fractures are admitted to the hospital. Prior to surgery, your health is evaluated and optimized, and there may be additional tests. If you hit your head during the fall, and/or take any blood thinners, your doctor may order a CT scan of your head as well.

General Treatment

Surgery is generally recommended for patients who have a femoral neck fracture. Treatment options include fixing the fracture with screws, or a plate and screws, or replacing part or all of the hip joint. Displaced fractures in which the bone ends no longer line up are commonly treated with some type of a hip replacement. A replacement can be a partial or total, and is based on many factors including age, activity level, and any pain in the hip joint before the fracture. A partial replacement replaces the femoral neck and the head. A total hip replacement replaces the neck and head as well as the hip socket or acetabulum. Your surgeon will discuss which type they think is best for you. Generally, you will undergo surgery occurs within 48 hours after the injury.

Postoperative x-ray of a patient with a displaced femoral neck fracture treated with a total hip replacement — Figure 4: Postoperative x-ray of a patient with a displaced femoral neck fracture, who was treated with a total hip replacement.

ostoperative x-ray of a patient with a displaced femoral neck fracture treated with a partial hip replacement — Figure 5: Postoperative x-ray of a patient with a displaced femoral neck fracture, who was treated with a partial hip replacement.

Postoperative x-ray of a patient with a non-displaced femoral neck fracture treated with screws — Figure 6: Postoperative x-ray of a patient with a non-displaced femoral neck fracture, who was treated with screws.

Postoperative Care

After surgery, patients do physical therapy both in and out of the hospital to rebuild strength. This is to restore normal walking. How much weight can be placed on the injured extremity depends on a number of factors. The goal of doing surgery for hip fractures is to get patients up and moving as soon as possible, in order to help prevent complications like bed sores, blood clots, and pneumonia. Patients with a fractured hip have a high risk of developing a blood clot in their legs, so are typically placed on some type of a blood thinner after surgery to help prevent clots.

Patients are discharged after a short stay in the hospital and return to see the operating surgeon in the first few weeks after surgery. You may need to go to a rehab or skilled nursing facility after leaving the hospital. This is generally to help you get stronger before going home. It is extremely important that patients follow instructions as provided to them by their treating surgeon.

Long Term

After surgery, patients generally require an assistive device such as walker or cane for at least a short period of time. After a fall, it’s very important to try and prevent all future falls. Some patients will require an ambulatory aid for the long term. Canes and walkers help prevent falls. It is also important to talk with your primary care doctor about your bone health, to try and decrease the risk of other fractures in the future.

Complications after femoral neck fracture are infrequent but can occur. They include blood clots, infections, difficulty ambulating, and walking with a limp. For some patients, long term risks include the bone not healing or healing in the wrong position, prominence of the implants used to stabilize the broken bone, and arthritis. Long-term complications of replacements include dislocation, fractures, or unequal leg lengths. For some complications more surgery may be needed.