Dr. M.J. Bazos, MD
Patient Handout
FEMORAL NECK
FRACTURE
About Your
Diagnosis
A femoral neck fracture is a break of the thigh
bone at the hip. This may be caused by a severe fall or an auto accident in
younger individuals, but it is much more commonly seen in older individuals,
particularly women. A femoral neck fracture usually results from osteoporosis or
thinning of the bone associated with increasing age. If the bone of the hip is
thin enough, even twisting can result in a break. Indeed, in many elderly
individuals, they may twist while standing, which causes the break, and then
they fall. As many as one fourth of all women older than 75 years may have
severe enough osteoporosis to experience a hip fracture. Hip fractures are
diagnosed by physical examination and an x-ray. Many individuals have a complete
recoveryafter
surgery.Living With Your
DiagnosisThe symptoms of a hip
fracture are pain in the hip, buttock, or pubic area, especially with movement
of the hip or leg. A frequently seen sign is shortening of the affected leg when
compared with the other leg. In addition, the foot of the affected leg will
frequently turn in. A later sign may be bruising on the hip, especially in thin
individuals.TreatmentTreatment
is nearly always surgical. There are a variety of surgical options depending on
where the hip fracture is located and on the condition of the bone. These range
from placing pins across the fracture to using metal plates and screws to hold
the bone fragments together. Other choices include replacing the ball of the hip
joint with a metal one, or replacing the socket as well as the ball. At times,
if the patient is in very poor health and cannot tolerate surgery, the treatment
may be bed rest to try to allow the fracture to heal. This has a very poor
success rate with many complications and is reserved for individuals who simply
cannot tolerate surgery. The main side effects of surgery are those seen with
any surgery: namely, infection and bleeding. Sometimes, the surgery fails to
stabilize the joint, usually because the remaining bone is too thin for the
artificial joint or the screws or pins to
hold.The
DOsYour doctor will prescribe
medications for pain. After most of the surgeries done now, a physical therapy
program is started, which will have the patient out of bed within a few days
after surgery. This is important to prevent weakening of the muscles. Pain
medicines will make this more comfortable and should be used appropriately to
speed recovery. An adequate diet to provide protein and calcium will speed
healing of the bone. Exercise in the form of physical therapy is a crucial part
of recovery from surgery. Most individuals will achieve a total recovery if they
are diligent in the physical therapy regimen. The prevention of hip fractures is
crucial. It is possible to slow or even reverse osteoporosis with appropriate
diet, exercise, and medical therapy, including hormone replacement therapy
(estrogen) for women who have gone through menopause. The stronger the bone, the
less likely you are to sustain a hip fracture. If osteoporosis is present, there
are medicines that may help reverse the process. You should discuss this with
your doctor. In addition, there are things to do in the home that will decrease
the chance of falls. These include adequate lighting and avoiding tripping
hazards such as loose rugs and poor-fitting shoes. Many home health agencies can
offer help in making the home
safer.The
DON’TsMedications that have side
effects of dizziness or drowsiness may increase the risk of falls. Medicines
such as steroids, thyroid medicines, and diuretics may increase osteoporosis and
should only be used if the benefits outweigh the risks of osteoporosis. Alcohol
and tobacco use increase the risk of osteoporosis, as does lack of
weight-bearing exercise. A diet low in calcium and excessive in protein
increases risk. A living environment with poor light and lots of tripping
hazards increase the risk of a fall. The most significant long-term adverse
effects of hip fractures have been pneumonia or blood clots to the lungs because
of prolonged bed rest. Indeed, this is largely why the outcome of nonsurgical
treatment is poor. With advances in surgical techniques that allow ambulation to
start within a few days after surgery, these adverse effects have decreased.
However, failure to comply with a physical therapy program, as well as prolonged
bed rest, will increase these
risks.When to Call Your
DoctorYou should call your doctor if
you have any increasing pain in your hip after surgery. This could be a sign of
infection, bleeding, or loosening of the hip replacement or screws. You should
also call if you are having increasing difficulty walking, because this also can
be a sign of loosening of the hip replacement. You should also call when signs
of infection are present, such as fever, or swelling or redness of the incision
line. Any shortness of breath and coughing should be reported to your doctor
because they could be signs of pneumonia or a blood clot to the lungs, which can
be complications of a hip
fracture.Websites:Description
of fractures and of surgical repairs: http://www.medmedia.com/oo4/156.htmDescription
of surgery and recovery: http://www.depuy.com/PatientEd/Hip/Hip.htmInformation
on osteoporosis: http://www.oznet.ksu.edu/dp_fnut/NUTLINK/pages/bones.htm