FEMORAL NECK FRACTURE

By: Maree Josephine Noelle D. Navarro

DEFINITION

• The femoral neck fracture is a crack near the hip joint, located between the top (head) of the bone of the leg and the main part of the latter. The femoral neck fracture often occurs in the elderly after a fall on the hip. Osteoporosis (bone degradation) contributes regularly to a broken bone. In severe osteoporosis, a simple’ bad’ movement may be enough to break a hip.

• Younger patients suffer from a femoral neck fracture most often after a violent shock, such as during a car accident or skis to cause this injury, the pressure on a young leg must be extremely violent. A femoral neck fracture requires an operation in the hours following the accident, to prevent necrosis of the femoral head (degradation and death of part or the entire top of the femur).

SIGNS AND SYMPTOMS• Inability movements immediate and complete• Extreme pain in the hip area, the leg can not be waived.• Increasing pain to the touch; optionally a swelling on

the side of the hip.• According to the fracture zone, the leg may be

shortened and turned to the side.• In rarer cases, the leg can not be turned to the side and

the pain may occur in the knee area; fracture risk of femoral neck and at first not to be suspected.

• Injury of blood vessels and nerves tends to occur in young patients, that is to say, after a violent collision.

DIAGNOSTIC EXAM

• Diagnostic confirmation using radiography (X-rays) of the basin

• Possibly a scanner (CT Computer Tomography)• Eventually an MRI (Magnetic Resonance

Imaging), primarily to exclude other injuries in the hip area

CT SCAN MRI

PATHOPHYSIOLOGY

• Following a fall or due to a direct blow to the hip or thigh, stress is placed on the femur. If these forces are excessive and beyond what the femur can withstand, a break in the neck of the bone may occur. When this occurs the condition is known as a femoral neck fracture and can vary from a small misplaced fracture to a severe displaced (and / or comminuted) fracture with obvious deformity.

TREATMENT AND MANAGEMENT

It is rare for a femoral neck fracture to be stable enough to perform a conservative treatment (without surgery). An operation is necessary in most cases.

Conservative treatment (no surgery)• Bed rest for 10-14 days• Stabilization of the leg• Prevention (prophylaxis) of thrombosis• Possibly a respiratory therapy• After 2 or 3 days begin rehabilitation, first

cautiously, then with a gradual increase of the load on the leg for 4 weeks.

Medical Drugs• Prevention of thrombosis• Optionally antibiotics in prevention of

infection• Pain

Types of surgery• The selected type of operation depends on

the overall health of the bone density and location of the fracture. In all cases, the operation should take place within 6 hours after the accident (risk of necrosis of the femoral head).

• Insertion of a screw (Osteosynthesis) is only possible at a density sufficient bone (not osteoporosis).– Advantage : fast operation, low damage to

surrounding areas, the natural joint of the leg (femoral head) remains in place.

– Disadvantage : there is the risk of a mismatch of the fracture and the formation of a false joint (pseudoarthrosis). After this operation, the leg can not bear immediately on body weight.

• Dynamic hip screw (metal plates and screws) : to stabilize, a metal plate is fixed to the upper leg and a thick is placed on the screw head of the femur. This operation is also possible that if the bone density is sufficient.– Advantage: quick operation, the natural joint of the

hip (femoral head) remains in place.

– Disadvantage: a shift of the fracture may occur. A complete application of body weight is not immediately possible. There is also a risk of necrosis of the femoral head.

• Artificial joint (prosthesis) of the hip : this type of operation is performed in elderly patients and with low bone density (osteoporosis). There are two possibilities: either a prosthetic femoral head is added to the main part of the leg bone (femur), which then slides into the hollow of the original hip joint, or the artificial joint complete – the femoral head and the hollow of the hip, that is to say a total hip replacement (PT) – is added.

– Advantage : the leg can support the weight of the body shortly after surgery. Rapid recovery of the patient avoids prolonged bed rest and reduces the risk of complications (pneumonia, pulmonary embolism, pressure sores).

– Disadvantage : bigger deal, big damage to surrounding areas. The hip prosthesis can deteriorate, requiring a new operation for the change.

NURSING CARE

• Pain: the nurse must assess the degree of pain the patient is in and administer prescribed analgesics. To keep the patient free of pain, move him/her for pressure area care and prevent other complications of immobility.

• Altered body function due to shock: the nurse must observe the blood pressure and pulse and report any change.

• Loss of mobility and confidence: a suitable type of walking and should be chosen.

• Activities of daily living: assist the patient when required to perform tasks related to daily living. (ex. Personal hygiene, eating and drinking, elimination )