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Femoral Neck Fracture

An intracapsular hip fracture common in elderly patients with osteoporosis, requiring urgent surgery.

Written by: Saygı Hospital Health Guide Editorial Board
Published:

This content is for general information; please consult your physician for diagnosis and treatment.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Ortopedi ve Travmatoloji department. Book Appointment →

What is Femoral Neck Fracture?

Femoral neck fractures occur in the region between the femoral head and intertrochanteric line, within the hip joint capsule. The vascular supply to the femoral head, mainly through the medial femoral circumflex artery and ligamentum teres, is highly vulnerable in displaced fractures, leading to risk of avascular necrosis and non-union.

Garden classification (I–IV) and Pauwels classification guide treatment based on displacement and shear angle. Other systems include Letournel, AO/OTA, and the more clinically used non-displaced vs. displaced dichotomy.

In elderly patients, femoral neck fracture is one of the most common reasons for emergency orthopedic surgery, with a 1-year mortality of 20–30%; multidisciplinary geriatric co-management improves outcomes.

Symptoms

Sudden severe pain in groin, hip, or anterior thigh after a fall
Inability to bear weight on the affected leg
Externally rotated and shortened lower extremity in displaced fractures
Tenderness over the greater trochanter and anterior hip
Painful range of motion, especially internal rotation
Occasionally minimal symptoms in non-displaced or stress fractures, but pain on weight-bearing

Risk Factors

Advanced age and osteoporosis
Previous fragility fracture, low BMI
Female sex (postmenopausal)
Vitamin D deficiency, malnutrition
Sarcopenia, frailty, recurrent falls
Long-term corticosteroid use, anticonvulsants, proton pump inhibitors
High-energy trauma in younger patients (motor vehicle, sports, fall from height)
Female athletes with low energy availability (stress fracture risk)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Inability to bear weight or severe hip pain after a fall in elderly
  • Persistent groin or thigh pain in young athlete with running training (stress fracture)
  • Suspected hip fracture: visible shortening and external rotation
  • High-energy trauma with hip pain, even if able to bear weight
  • Pain in known osteoporosis after minor trauma

Treatment Methods

01
Urgent emergency department evaluation: AP and lateral hip X-rays, CT or MRI if X-ray negative
02
Pain control, traction is no longer routinely recommended; early mobilization-friendly positioning
03
Non-displaced or impacted fractures (Garden I–II): in situ percutaneous cannulated screw fixation or sliding hip screw
04
Displaced fractures (Garden III–IV) in elderly: hip arthroplasty (hemiarthroplasty for low-demand patients, total hip arthroplasty for active patients)
05
Displaced fractures in younger patients (<60–65): urgent anatomic reduction and internal fixation, often within 6–12 hours
06
Surgery within 24–48 hours reduces mortality and complications in geriatric patients (per modern guidelines)
07
Multidisciplinary care: orthogeriatric co-management, VTE prophylaxis, fall prevention, secondary fracture prevention with bisphosphonates/denosumab/zoledronate, vitamin D and calcium
08
Early postoperative mobilization, structured rehabilitation, ortho-geriatric follow-up

Which Department to Visit?

You can visit our Ortopedi ve Travmatoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.