Do you suffer issues related to a fracture neck of femur? You may be young and might have got injured in a major accident.
Fracture neck of femur occurs in two populations. a) In the elderly it is a result of house hold falls from a standing height. b) Younger patients also sustain a femoral neck fracture from high energy mechanism. This occurs after a major road accident or fall from a height.
The fracture can be either intra capsular or extra capsular.
An intra-capsular fracture occurs through hard cortical bone. Fracture healing can be an issue. Later Avascular necrosis becomes an issue.
An extra capsular fracture occurs in spongy cancellous bone. Healing can occur but malunion is a possibility. Fractures of neck of femur are a leading cause of morbidity and mortality in the elderly. They are a surgical emergency.
The treatment depends on the location, type of fracture, bone quality, age and co morbidities. Non operative care is reserved for bed ridden patients with neurological disturbances or insensate.
Most patients with femoral neck fracture benefit from surgical intervention.
An intra capsular fracture neck of femur is treated by bipolar hemi arthroplasty in elderly patients.
Cemented bipolar is used in the very elderly patient with poor osteoporosis. In younger patients, uncemented biploar hemi-arthroplasty is used. Rarely total hip replacement may required when there is pre existing arthritis of the hip.
In younger patients, the first treatment is internal fixation. Getting an accurate reduction is very important. A successful outcome is dependent on a proper reduction and stable fixation. The recommended method of fixation is with screws or a DHS.
In some cases even with properly done internal fixation, there is a risk of non-union and avascular necrosis. Both can result from inadequate fixation or sometimes even with proper fixation. Further treatment is then required. In a non union, an osteotomy can be done. When osteotomy fails, total hip replacement is indicated.
Avascular necrosis is another complication. Stem cells are available to treat avascular necrosis in the early stages. When degenerative changes or arthritis sets in, a hip replacement becomes necessary.
In the example given below, a non union following femoral neck fracture is seen. This was treated by Total hip replacement. Uncemented ceramic hip replacement is a good choice in young patients as it can last for very long period. You need not go through a second operation after some time.
I offer uncemented hip replacement with ceramic head and liner for such patients.
Extra capsular fractures are treated by a sliding screw or proximal femoral nail (PFN)
Non unions or AVN can result as a failure of the above treatment.