Fracture of the femur
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What causes femoral neck fractures in older people and what causes them in younger people? What are the symptoms? What surgical solutions can be used to treat it? How long does it take to heal?With the help of the specialists at the Budapest Musculoskeletal Private Clinic, we have gathered the most important facts about femoral neck fracture.
Causes of femoral neck fracture
Fracture of the femoral neck is a very common injury, more common in older people than in younger people. The immediate cause is most often a fall that involves a blow to the hip area. The fact that bone density decreases with age, making the bones more brittle, also contributes to the development of femoral neck fractures.
After the menopause, this process is more pronounced in women because of the decrease in oestrogen levels, which is why they are more likely to suffer from femoral neck fractures. A diet low in nutrients (such as calcium), sedentary lifestyle, certain digestive disorders and hormonal problems may also contribute to bone loss. And the risk of falling is increased by diseases that negatively affect the sense of balance (such as Parkinson's disease and stroke).
Dr. Péter Doszkocs
Orthopaedic traumatologist, hip and knee surgeon, lower limb specialist, robotic surgeon
Fracture of the femoral neck caused by osteoporosis
Osteoporosis also plays a major role in the development of femoral neck fractures. It is a very insidious disease, as it typically causes no pain, so it very often goes untreated. The osteoporosis (bone loss) essentially a qualitative and quantitative deterioration or reduction in the organic and inorganic bone stock. It is more common in women, older people and people of thin build. Smoking, excessive alcohol consumption, a diet low in calcium and a sedentary lifestyle are also risk factors for osteoporosis.
The bone mineral density test gives an accurate picture of the bone mineral mass. The aim of treating osteoporosis is to prevent or slow down further bone loss, thereby reducing the risk of fracture of the femoral neck. This can be achieved with a complex treatment, including taking calcium, vitamin D and other vitamins, and regular exercise. To do the latter, it is advisable to consult a physiotherapist who will design and teach the patient an exercise programme of the right intensity and strength for him or her.
Age-related fracture of the femoral neck
This injury is more common in older people. It typically occurs when they fall and their hands do not reach their hips before they hit the ground. If an older person falls and has pain around the hip, an X-ray should be taken immediately, as a fractured femoral neck often requires surgery as soon as possible to avoid further complications.
Fracture of the femoral neck in juveniles
Fractures of the femoral neck can also occur in young people, although much less frequently than in older people. It typically occurs in car accidents, when the dashboard “hits” the driver, causing a very hard blow to the knee, and the axial load can cause a femoral neck fracture. In such accidents, it is not the femoral neck but the pelvis that is injured, with the femoral head „knocking out” the rear edge of the femur.
Symptoms of a fractured femur
The symptoms of a fractured femoral neck are typical. The leg is twisted and shortened almost immediately after the fall. The patient is unable to lift or move the limb and develops a complete inability to walk, accompanied by severe hip pain. There is also swelling and bruising on the hips.
There is a much rarer form of this injury, called a wedged femoral neck fracture. In this type, the femoral head does not break off the femoral neck, but the femoral neck slides into the femoral head and the patient can walk. This type does not have the typical symptoms, which is why if an elderly person falls and has hip pain, it is always advisable to have an X-ray, as a subsequent dislocation can cause serious complaints.
Types of femoral fracture
Fracture of the femoral neck can be dislocated (displaced) and non-displaced (not displaced). One type of displaced fracture is when the bone is only slightly displaced along the fracture, while the other type is when a part of the bone is completely detached from another part of the bone. Fractures of the femoral neck can be intra-articular and extra-articular.
Treatment of a fracture of the femur
The world has changed a lot in the treatment of femoral neck fractures. In the past, the two broken bone ends were typically ‘screwed’ together’. After this type of surgery, it is important to relieve the weight on the limb. Today, it is used only in younger patients and only if there is no major displacement of the femoral neck. It is important that the broken bone ends are put back into place and fixed as soon as possible to maintain blood circulation and the viability of the femoral head. Hip replacement surgery is a much more common option today, which achieves complete pain relief, early full weight bearing and allows the patient to use the foot in its original function.
Surgical treatment of a fractured femur
In older patients, a hip replacement is always implanted for a fractured femur. A very good thing about this method is that after implantation, there is no need to unload the limb, patients can get out of bed the next day. In younger people, if the injury allows, they try to heal it by screwing. If the fracture is large, hip replacement surgery is also the solution for younger patients.
In terms of hip surgery and the surgical technique chosen, young people are typically considered to be under 60 years of age, but more recently the quality of bone mass has become more of a factor in determining who is young and who is old. Even a 75-80 year old man with very good bone structure can have a glueless prosthesis implanted. On the other hand, a 60-year-old patient may have such advanced osteoporosis that a cemented prosthesis is the only option.
Hip replacement implantation
Younger patients are mainly implanted with cementless prostheses, while older patients are typically implanted with cemented prostheses. When cemented prostheses are implanted, a bonding agent is used between the prosthesis and the bone, but this is not necessary for cementless hip replacement types because the surface of the prosthesis has a special structure that the bone can grow onto.
When the implant is inserted, the patient's femoral head is first removed and the cartilage is removed from the pelvic bone and scraped up. Then a hemispherical metal socket is implanted, into which a hardened plastic insert is inserted or a plastic socket is glued with bone cement. The metal stem of the prosthesis is then implanted into the femoral marrow cavity. The stem is then fitted with a metal or ceramic ball head, which moves in the plastic part of the socket, replacing the function of the original joint. Patients do not experience significant pain immediately after hip replacement surgery, thanks to an anaesthetic injection into the wound at the end of the operation. After the hip replacement and rehabilitation period, patients who have suffered a fractured femoral neck can regain full use of the limb.
Partial prosthesis implantation
Pariprosthesis is usually performed in the oldest age group. The big advantage is that it is a very quick surgical technique. After removal of the fractured femoral neck and femoral head, a stem is glued into the femur, onto which a smaller head is inserted, and then a larger head is attached. The pelvic part of the hip joint is not touched so that the large head can move in the pelvic part and the small head in the large head. This solution is also called a bicontact prosthesis. It is a quick operation and immediately after the operation the limb can be loaded and the joint can regain its full function.
Revision hip replacement surgery
Revision hip replacement surgery involves the replacement of a previously implanted hip replacement. This is usually necessary when the previous hip replacement has reached the end of its life. All hip implants are a foreign substance in the body that has no living properties, so like dental fillings, they loosen over time. This happens because, as the wear material of the prosthesis wears away, wear products accumulate around the joint and trigger a tissue reaction that results in the bone around the prosthesis being absorbed. With today's modern implants, components may loosen after about 15-20 years, which may require replacement of the prosthesis, but there are also prostheses that have been in place for longer periods without complaints.
In Hungary, in patients under 70 years of age, cementless hip replacement is more common, as it has the great advantage that if the implant needs to be replaced later in life (i.e. revision hip surgery), the hip replacement surgery can be performed with much less bone loss than cemented hip replacement.
Fracture rehabilitation
Physiotherapy following hip replacement surgery is an extremely important part of a quick and complete recovery. For young people, it is very important not to lose the good musculature and range of motion that they had. And for older patients, it is important to help them learn to move independently and safely again as soon as possible.
Fracture of the femur - Physiotherapy exercises
After surgery for a fracture of the femoral neck, physiotherapy plays a key role in recovery. The aim of physiotherapy is initially to restore range of motion and strengthen the hip muscles. The physiotherapy starts in the hospital and continues in the patient's home.
It is important that a qualified physiotherapist sets up the exercise sequence, taking into account the doctor's instructions (whether the limb can be fully or partially loaded or whether no weight can be placed on it), and the individual characteristics of the patient and the injury.
In the later stages of physiotherapy, the physiotherapist will teach exercises that help you to perform the tasks you need to do in everyday life (e.g. sitting on a chair, sitting on the floor, standing up, lifting, getting on and off the bus, picking up shoes, etc.).
Fractured femur - How long does it take to heal?
After the implantation of glued prostheses, the patient can bear the full weight of the limb after practically 1 day. The only reason patients are given some kind of aid is to increase their stability and sense of security. After 6 weeks after hip replacement, the patient can move without an assistive device and can use the limb with full function.
The implantation of hip replacements without adhesive patients have previously been treated with a partial load. Nowadays, however, with advances in technology and implants and the use of so-called collar prosthesis stems, it is possible to apply a full body weight to these prostheses after surgery.
If the fracture of the femoral neck was treated with a screw-synthesis surgical technique, the limb must be completely unloaded after the operation. The patient can touch the ground, but cannot put the weight of the body on it - doctors usually ask the patient to do this for up to 6 weeks.
Prevention of fracture of the femur
To prevent fractures of the femoral neck, it is important to exercise regularly according to your ability and physical condition, and to eat a nutrient-rich diet, paying particular attention to calcium and vitamin D intake.
Women are recommended to have a bone density test after the menopause, and men over 70, to detect osteoporosis in its early stages. This can prevent deterioration through medication and lifestyle changes.
The part of preventing a fracture of the femoral neck is to minimise the chance of falls. Movement that also develops the sense of balance can help. In addition, for older people or those who have difficulty moving, it is recommended to install handrails in the home and use anti-slip mats.
Our hip replacement doctors:
Dr. Zoltán Bejek PhD
Associate Professor of Orthopaedics, Robotic Surgeon
Dr. Szabolcs Gáspár
Orthopaedic traumatologist, head of department, robotic surgeon
Dr. Péter Molnár
Orthopaedic traumatologist, chief operating surgeon, robotic surgeon
Dr. Gergely Holnapy PhD
Orthopaedic traumatologist, assistant professor, robotic surgeon
Dr. Péter Doszkocs
Orthopaedic traumatologist, hip and knee surgeon, lower limb specialist, robotic surgeon