Femoral neck fracture
definition
A femoral neck fracture is one Broken bone in the area of the femoral neck. The femoral neck anatomically forms the connecting piece between the femoral head and the femoral shaft.
Depending on the location, a distinction is made between different types of femoral neck fracture. If the fracture lies within the joint capsule, it is called a medial femoral neck fracture. If the fracture occurs outside of the capsule, the fracture is classified as a lateral femoral neck fracture. This division plays an important role in the management of the femoral neck fracture. The femoral neck fracture is one of the most common surgical indications in trauma surgery and primarily affects older women.
The most common mechanism of accidents is a fall on the hip. Older people in particular have problems walking safely. On the one hand, this is due to age-related restrictions in gait security; on the other hand, a multitude of diseases that often occur in old age, such as high blood pressure or osteoporosis, can make gait unsafe. In addition, the bone itself is no longer as break-resistant in older people as in young people. The already mentioned osteoporosis in older women is an important cause of this. But malignant diseases (cancer) can also reduce bone density and thus increase the risk of fractures. With the help of a bone density measurement, the severity of the osteoporosis and thus the risk of fractures can be estimated.
Frequency and gender distribution
The femoral neck fracture is a relatively common fracture that mostly occurs in older women. The risk in men to suffer a femoral neck fracture once in a lifetime about 10%, in women about 20%.
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The hip joint is one of the joints that are exposed to the greatest stress.
The treatment of the hip (e.g. hip arthrosis, hip impingement, etc.) therefore requires a lot of experience.
I treat all hip diseases with a focus on conservative methods.
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Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.
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root cause
By far the most common cause of femoral neck fracture is the Fall on the hip. Since falls are the most common among the elderly, femoral neck fractures often occur in old people. In addition, especially in older women with osteoporosis, the Reduced bone density is. As a result, the bone is no longer as stable and it is easier for bones to break. Other comorbidities such as Dizziness, high blood pressure, or heart problems can severely impair walking security and so lead to falls. For this reason, femoral neck fractures often occur in old people's homes and hospitals, i.e. where there are many old and often sick people. Especially when older people try to get up alone after being bedridden for a long time, for example to go to the toilet, the overestimation of themselves when walking leads to falls and breaks.
Also are older people are also more likely to be affected by malignant cancer. Bone tumors, like osteoporosis, can make the bones fragile. Primary bone tumors, i.e. tumors that arise directly from bone tissue, are far less common than bone metastases ("tumorableger" of a type of cancer in another organ in the body), as can often be observed in breast, prostate and lung cancer. A spontaneous fracture of the bone without great force can be an indication of cancer.
Symptoms
A femoral neck fracture, which often occurs during a fall, can manifest itself through a variety of symptoms. In the foreground is certainly one severe pain in the thigh on the affected side. This occurs especially under stress on, many patients complain already in peace about pain. The pain does not have to be strictly localized to the hip region. Depending on the extent of the injury, the pain can also radiate to the back or leg. Are visible from the outside with the patient Hematomas (bruises) caused by falling on the hip. Depending on the severity of the fall, such a hematoma can become large and even require surgical treatment.
Often there is also a fracture of the femoral neck Shortening and misalignment of the affected leg. The leg is rotated outward in the hip and can often only be returned to its starting position with severe pain. In very few cases, patients can still put weight on the leg after a femoral neck fracture, so that they cannot get up on their own. In this case, they are dependent on the help of outsiders or notify the emergency doctor directly.
diagnosis
The first step in diagnosing a femoral neck fracture is Medical history by the doctor, so a conversation about the cause of the rupture and the existing symptoms. The doctor is primarily interested in how exactly the femoral neck fracture occurred, i.e. whether a fall has occurred or whether the patient has a particular problem Pre-existing conditions such as osteoporosis suffers. In most cases, the doctor can make the suspected diagnosis of a femoral neck fracture immediately after taking the medical history.
In the next step, a Imaging. Here is that X-ray of the hip the method of choice. In the case of complicated processes such as multiple trauma, a Computed Tomography be performed. In the X-ray, the doctor either sees one directly Fracture gap on the femoral neck or a anatomically incorrect position of the joint. This can happen if the individual bone fragments shift against each other in the event of a fracture. If a femoral neck fracture is diagnosed, surgery is almost always required for treatment. In the case of unclear fracture lines on the X-ray or in the case of very severe fractures, a computer tomogram can be made in addition to the X-ray. With the help of this additional imaging, the operation can be better planned. In addition, you can still Concomitant injuries, such as further fractures of the thigh bone.
Classification of the femoral neck fracture
Femoral neck fractures can be classified according to three different schemes. There is Garden schemethat after Pauwels and the AO classification. In Germany, the AO classification is primarily used.
Classification according to Garden
In the classification according to Garden four degrees of severity are divided, whereby here the deviation of the individual fracture parts (Dislocation) is in the foreground.
Garden grade I and II have only one slight dislocation of the femoral head to the femoral neck in front. In these two cases, the prognosis is very good with early treatment, so not always operated on must be and it rarely leads to complications comes in the course of the disease.
Grade III and IV are more severely dislocated and must be brought into the correct axis position immediately. In addition, surgery is almost always indicated. With Garden Grade III and IV it occurs more frequently in the course severe complications such as femoral head necrosis or developing one Pseudoarthrosis.
Classification according to Pauwels
The classification according to Pauwels has in medicine more of an academic value. Pauwels distinguishes between three different degrees of severity. Here is mentally drawn a horizontal line over the X-ray image and then the Angle between the horizontal and the fracture line measured. Pauwels I denotes a distraction of the femoral neck up to 30 degrees. Between 30 and 50 degrees one speaks of a Pauwels II femoral neck fracture. Stage III according to Pauwels is reached from 50 degrees. The higher the severity according to Pauwels, the worse the prognosis for the patient.
therapy
The femoral neck fracture represents almost always an indication for surgical treatment There are different approaches to treat the fracture. What kind of surgery will be done decided based on various factors. This includes above all that Age of the patient, but also the Location and type of the break play an important role.
In the operation of the femoral neck fracture, there are essentially two different approaches: holding the femoral head or with an endoprosthesis.
Femoral head preserving OP / DHS
On the one hand, it tries to To obtain femoral head and not having to replace it with a prosthesis. This approach is particularly useful in young patients, as the joint is often only slightly damaged. The hernia is supplied with various Screws and plateswhich differ in form and function depending on the fraction.
The so-called dynamic hip screw (DHS) The DHS is primarily at lateral (lateral) and pertrochanteric (lying between the two bones) Femoral neck fractures used. With the help of the dynamic hip screw, the individual bone fragments are increasingly pressed together so that they can grow together as physiologically as possible.
The big risk with the femoral head preservation strategy is the so-called Femoral head necrosis. This arises because the fracture hinders the blood supply to the bone in the area of the femoral head can be. As a result, the bone dies irretrievably and must be surgically removed to avoid serious complications. It is therefore important to treat femoral neck fractures in young patients as early as possible in order to prevent femoral head necrosis. In this case, the operation should be seen as an emergency procedure.
Endoprosthesis for femoral neck fractures
This is different in older patients with a femoral neck fracture. The operation is easier to plan because the hernia does not have to be treated immediately. Be here in most cases resorted to hip prostheses for care. Either only the femoral head can be replaced or the acetabulum as well. The procedure is decided individually by the patient.
Advantage: A great benefit to using dentures is that the patient Put weight on your leg again immediately after the operation can and should. Bed restraint is a major problem in medicine, especially with older patients, and this treatment strategy can prevent this.
Risk: The introduction of foreign bodies into the patient poses a great risk infection if this occurs and not be conservative with Antibiotics can be controlled, another operation may be necessary in which the prosthesis must be removed again.
prophylaxis
When preventing a femoral neck fracture, there is a healthy and conscious lifestyle with a balanced diet and exercise in the foreground. The movement strengthens the muscles and bones and there are fewer falls and breaks. A healthy diet is also important for the stability of the bones. In older patients it is Preventing falls in the foreground. The safe use of walking aids is essential for prophylaxis. Also should Cardiovascular disease treated well to prevent falls from dizziness or fainting. This is especially true for women osteoporosis a major risk factor and should be used for prophylaxis of femoral neck fracture recognized early and treated adequately become.
forecast
The prognosis of patients with femoral neck fractures is difficult to generalize. It many different factors play a role in the assessment. These include above all the age of the patient, but also comorbidities and lifestyle. If a patient develops femoral head necrosis or an infection, the prognosis for the function of the joint is rather poor. If the procedure and the follow-up care are uncomplicated, the patient can put minimal strain on his joint in the long term.
