FEMORAL NECK FRACTURES

Femoral neck fractures are most commonly found in the elderly after a fall. Osteoporosis due to aging often leads to femoral neck fracture. These fractures occur below the femoral head and above the greater trochanter and are much more common than femoral head fractures. In the elderly, femoral neck fractures result from a fall while standing. Three common mechanism are : Direct trauma to the hip/Fall directly onto the greater trochanter lateral rotation with sudden increase in load spontaneous completion of a stress fracture that cause the fall (incidences increased with severity of osteoporosis) 1. Femoral neck fractures & Pain For many years, it has been known that bones are innervated with sensory neurons. Yet, their exact anatomy remained obscure due to the contrasting physical properties of bone an neural tissue.The stimulation of the nociceptors that innervate bone tissue leads to the sensation of bone pain. These nociceptors responsible for bone pain can be activated via several mechanism including detonation of surrounding tissue, bone destruction. Bone pain originates from both periosteum and the bone marrow which relay nociceptive signals to the brain creating the sensation of pain. 2.Management of femoral neck fractures Acute Phase Open reduction ( a method where the fracture fragment are exposed surgically by dissecting the tissue) Internal fixation (fixation of screws an or plates to enable facilitate healing) Total hip athroplasty Recovery Phase Physical therapy (strengthening exercises for the hip stabilizers & associated muscles can be initiated) Once the patient is pain free (weight bearing can progress, swimming, cycle)

3. Complication of femoral neck fractures Non-union Failure of union of this fracture still occurs due to improper reduction of imperfect internal fixation. When this occurs, the patient complains of pain and develops instability on walking. Avascular Necrosis Avascular necrosis of the head of the femur is an unpredictable complication met with after any type of internal fixation. The patient presents with pain in the hip and limping. There is limitation of all movements of the hip with muscle spasm. Radiography shows patchy areas of increased density in the head of the femur. Treatment in the early stages is by rest, traction and weight relieving caliper. When indicated, osteotomy or replacement arthroplasty is done.