1.What is the femoral neck?
The femur is the largest long tubular bone in the human body and is divided into three parts: the proximal femur, the body of the femur and the distal femur. The proximal femur faces inward and upward, and its end is enlarged and spherical, called the femoral head, which is involved in forming the hip joint, and the thinner part of the femoral head is called the femoral neck. In older patients, fractures are likely to occur.
2.What is a femoral neck fracture?
The medical definition is a fracture from the femoral head down to the base of the femoral neck, mostly seen in middle-aged and elderly people, prone to fracture non-union and often femoral head necrosis.
3. Why are femoral neck fractures likely to occur in the elderly?
More than 90% of femoral neck fractures occur when standing or walking, because the elderly have osteoporosis and reduced bone mass, which can cause fractures even with minor external forces, so they are more common in elderly patients.
4.What are the symptoms of femoral neck fracture?
Patients will have hip pain, cannot walk, cannot cross their legs, but sometimes patients may also have subjective pain is not obvious or even can walk, need to check the patient carefully.
5.What should I do when I suspect a femoral neck fracture?
Because of the deep location of the hip, it cannot be easily fixed and braked, the most reasonable treatment is to let the patient lie down and contact the transfer hospital for treatment as soon as possible.
6.How is a femoral neck fracture diagnosed?
A history of low-energy trauma (more than 90% of femoral neck fractures are caused by falls while standing or walking), post-injury hip pain, inflexibility of the lower extremity, or inability to walk, shortening of the injured leg compared to the other side, or outward rotation of the injured leg, should be considered as a possible femoral neck fracture. In some cases, there may be other types of fractures, and in case of high-energy trauma (such as car accident, strong impact, etc.), there is also the possibility of hip dislocation, and routine X-ray examination can generally clarify the diagnosis, and in some unclear cases, CT can assist in clarifying the diagnosis.
7.What is the role of X-ray and CT examination for femoral neck fracture?
Firstly, X-ray and CT can clarify the diagnosis, secondly, there are many types of femoral neck fractures, and different diagnosis and different classification (e.g. Garden type I-IV according to the degree of displacement, subtrochanteric type, transcranial type and basal type according to the location of the fracture line) will bring different treatment plans, which all depend on the information provided by X-ray and CT to the doctor.
8. How are femoral neck fractures treated?
Artificial joint replacement is recommended for patients over 65 years of age, and for patients over 55 years of age who are in poor general condition and have significant fracture displacement. For the rest of the patients, internal fixation surgery (surgical fixation of the broken bone with plates, screws, etc.) is recommended.
9.Why is internal fixation not used in elderly patients with femoral neck fractures?
In elderly patients, the chance of poor healing of femoral neck fracture is reported to be as high as 60% and the chance of femoral head necrosis is reported to be as high as 78%, in such cases, the chance of failure of internal fixation surgery is very high and femoral head necrosis is likely to occur, so joint replacement (replacement of the femoral head containing the femoral neck and partial hip bone with an artificial device) is generally recommended.
10.How to fix the femoral neck fracture surgically?
Currently, the mainstream surgical approach is to fix the fracture with a few hollow screws and apply pressure to the fracture end to promote healing.
11.When is the internal fixation usually removed after femoral neck fracture surgery?
Under normal circumstances, when the patient can walk normally without obvious discomfort and the fracture line has disappeared as indicated by X-ray examination, the fracture healing standard is basically reached.
12.Does a femoral neck fracture necessarily require surgery?
Because the patient cannot walk after the fracture of the femoral neck, long-term bed rest will bring a series of complications such as decubitus ulcers, pneumonia and other complications, the patient should try to choose surgery as much as possible to resume walking as early as possible when the patient’s physical condition allows. Of course, conservative treatment will only be considered for patients of advanced age and poor general condition who cannot tolerate surgical treatment.
13.What are the methods of conservative treatment for femoral neck fracture?
The main method of conservative treatment for femoral neck fracture is traction therapy, so that the fracture part can maintain its normal position and rely on the bone’s own growth ability to achieve fracture healing. There are skin traction and bone traction. The advantage of skin traction is that it is non-invasive and simple to operate, but the disadvantage is that the traction effect is poor and long-term traction is prone to skin complications, and the patient feels uncomfortable subjectively. Skeletal traction is performed through the bone, which has the advantage of good fracture reduction and long-term traction without significant discomfort to the patient, but has the disadvantage of being an invasive operation, usually performed under local anesthesia, with the risk of infection. Because patients who choose conservative treatment are often in poor general condition, skeletal traction is the first choice under conditions that can be tolerated.
14.What are the chances of osseous nonunion of femoral neck fracture?
However, this criterion is generally applied to long tubular fractures, which are more likely to develop due to the lack of local nourishing blood supply after femoral neck fracture. The diagnosis of osteonecrosis can sometimes be made by imaging at 3 months postoperatively, with statistics showing that approximately 15% of patients will develop osteonecrosis.
15. What should I do if I have a femoral neck fracture with bone nonunion?
There are two main types of treatment for postoperative osteochondral nonunion in femoral neck fractures: preserving the hip joint and not preserving the hip joint. In preserving the hip joint, there are autologous bone graft, bone marrow stem cell transplantation, bone flap transplantation with blood supply, replacement of fixation and some physiotherapy, etc., while the one that does not preserve the hip joint is generally joint replacement. The choice of hip joint preservation treatment method is limited by technical strength, equipment and experience, etc. The overall effect varies from person to person, while the treatment effect without hip joint preservation is relatively certain.
16.Why are femoral neck fractures prone to femoral head necrosis?
Because the nourishing blood vessels of the femoral head form an arterial ring at the junction of the femoral head and the femoral neck to supply blood to the femoral head. Fracture of the femoral neck will destroy the arterial ring, resulting in the loss of most of the blood supply to the femoral head, which eventually leads to necrosis of the femoral head.
17.What is the chance of femoral head necrosis after femoral neck fracture?
It is generally believed that the incidence of femoral head necrosis after femoral neck fracture is 20% to 30%, and the risk of femoral head necrosis is higher in patients with severe trauma, advanced age and obvious fracture displacement. At the same time, femoral neck fractures have a complex subtype in the specialty, and some specific types of fractures are more likely to develop femoral head necrosis.
18.How to avoid femoral head necrosis after femoral neck fracture?
The vulnerability to femoral head necrosis after a femoral neck fracture is due to its special anatomical structure of poor blood supply, which cannot be avoided. Once a femoral neck fracture occurs, the most important thing that patients need to pay attention to is to reduce the burden on the hip, try to focus on non-weight-bearing exercises, reduce the use of the hip joint, rest more, and try to maintain the femoral head from collapsing, so that even though femoral head necrosis cannot be avoided, the ensuing pain will be reduced, and then the time of joint replacement can be further postponed.
19.How to diagnose femoral head necrosis early after femoral neck fracture?
In the early stage of femoral head necrosis after femoral neck fracture, signs such as femoral head collapse and increased density can be found on the x-ray. For patients after internal fixation removal, if there is hidden pain in the hip, the possibility of femoral head necrosis should be considered first. When there is no obvious change on the X-ray, magnetic resonance imaging (MRI) may be more sensitive to detect early femoral head necrosis.
20.What is joint replacement?
Artificial joint replacement is a method of replacing a painful and non-functional joint with an artificially made joint. Hip and knee replacements are relatively mature, and the clinical application of shoulder, elbow and ankle replacements is gradually maturing.
21.What are the risks of artificial joint replacement surgery?
However, there are still some risks associated with the surgery, such as infection, joint dislocation, loosening, periprosthetic fracture, bone cement reaction (see later), etc. In addition, since the patients of this type of surgery are often of advanced age, due to the trauma of surgery and anesthesia Complications to other organs are also an important part of the surgical risk.
22.What is the difference between total hip replacement and hemi hip replacement for femoral neck fracture?
The hip joint is composed of two parts: the acetabulum and the head of the femur. Total hip replacement means that both the acetabulum and the head of the femur need to be replaced, while hemi hip replacement is the exact term for artificial femoral head replacement, as the name suggests, only the head of the femur is replaced.
23.When to choose total hip replacement and hemi hip replacement?
This requires consideration of the patient’s age, physical condition and activity level. The hemi hip joint is less traumatic than the total hip joint, and the life span of the artificial joint is shorter, so it is suitable for patients with limited life expectancy, poor physical condition and low activity; patients with long life expectancy, good physical condition and high activity need to choose total hip joint replacement.
24.What is the need for bone cement in artificial joint replacement surgery for femoral neck fracture?
Artificial hip joints are divided into two categories according to the different fixation methods, biological type and bone cement type. Biologic artificial joints do not require bone cement, and are generally suitable for patients with good bone quality. The scientific name of bone cement is methyl methacrylate, which is used as a binder in artificial joint replacement surgery, only for patients with severe osteoporosis, who need the bonding effect of bone cement to fix the artificial joint to achieve satisfactory stability.
25. Is bone cement dangerous? Is there no alternative?
Bone cement may enter the circulation during use because it is cytotoxic, causing reactions such as decreased blood pressure and increased heart rate in patients, which can lead to death in severe cases. In the 38488 cases of cemented hip replacements performed at the famous Mayo Hospital in the United States from 1969 to 1997, the mortality rate of toxic reactions to bone cement was 0.078%, which shows that the use of bone cement is safe. At present, the third generation of bone cement technology is widely used in clinical practice, and its safety has been greatly improved compared with that of the past, and there is no alternative product for the time being.
26.How long does the artificial joint normally last after femoral neck fracture surgery?
The theoretical service life of the artificial joint is generally 20-25 years.
27.Which one will last longer, the imported hip joint or the domestic hip joint?
However, the service life of the artificial joint is closely related to the type of prosthesis, the way of fixation, surgical technique and use, etc. Moreover, a large number of clinical applications have proved that the domestic joint can fully meet the needs of patients.
28. What should I do when the artificial joint reaches the end of its service life after femoral neck fracture surgery?
If the artificial joint reaches the end of its service life, it will loosen, and the patient will have hip pain and walking disorder again, then it is necessary to perform joint revision surgery according to the patient’s specific situation, that is, to perform artificial joint replacement again.
29. What is the rehabilitation effect after the artificial joint replacement for femoral neck fracture?
The purpose of artificial joint replacement is to restore the patient’s normal walking as soon as possible, so theoretically you can leave the bed immediately after surgery. In practice, patients can start to leave the bed as soon as possible after their general and local conditions have stabilized.
30. What do I need to pay attention to after the fracture joint replacement?
The most important thing after joint replacement is to pay attention to the correct use, avoiding unsafe movements such as deep squatting, cross-legged and internal retraction, etc. Under the premise of correct use, patients can live a normal life.