Fracture of the neck of the femur: how to treat it?

2020-12-17 10:48:54

More than 60,000 people are operated on each year in France for a fracture of the neck of the femur. It is the elderly over 70 years old in the vast majority of cases. “11.5% of fractures received in the emergency room concern the upper end of the femur”, observes Dr. Claire Bastard, orthopedic surgeon at Henri-Mondor hospital (Créteil) who points out that this type of accident is on the increase, from due to the aging of the population.

What is a femoral neck fracture?

“The fracture of the upper (or proximal) end of the femur, also called hip fractureis a fracture of the neck of the femur or trochanter »explains the Health Insurance (source 1).

Why speak of femoral neck fracture and trochanteric fracture?

At its end, just before fitting into the hip bone, the femur (one of the long bones of the leg) forms a fairly thin angle. However, this fragile area, the famous “neck of the femur”, supports the weight of the body. Nearby, another part of the femoral head, the trochanter or trochanteric massif, can also yield in case of osteoporosis. At the level of the trochanter, we then speak of a trochanteric fracture.

Women more affected than men

THE women are three times more likely than men to suffer a femoral neck fracture. They are, in fact, more affected by osteoporosis, this demineralization of the bone which manifests itself, most often, following menopause. Since the bone is more fragile, it breaks easily. THE femoral neck at hip levelbut also the wrist and the vertebrae, are the most frequent localizations.

In an elderly personthe fracture often occurs in a single fall :

The typical accident is the person who trips on the carpet, or who is the victim of a malaise, and falls from its height, notes Dr. Bastard.

Characteristic symptoms of a hip fracture

The pain is the first symptom of a femoral neck fracture. In rare cases, the bone is not displaced: the person can still walk.

But most often, it presents characteristic signs detailed by Dr. Bastard: “the patient presents with functional impotence: he can no longer walk. A doctor can guess the fracture by observing a shortening, as well as an external rotation of the affected limb. Another characteristic sign, called clinostatism : when the patient, lying down, is asked to take his leg off the bed, he is unable to do so”.

X-rays, an essential examination, will make it possible to visualize the fracture. Several shots are taken: at the level of the pelvis and the hip (face and profile).

Fracture of the femoral neck: the operation is almost systematic

There is not a single fracture of the neck of the femur, but several forms, of different severity. The treatment will not be the same depending on the case. The only common point: the surgical operation is systematicunless contraindicated in extremely fragile people.

Depending on the type of fracture, hip prosthesis or osteosynthesis

Surgical treatment varies depending on the state of the capsulethis set of fabrics in the form of a sleeve which encloses the joint.

• ” And the fracture is displaced in coxa vara (closed angle, editor’s note), there is a high risk of lesion of the main artery which vascularizes the head of the femur, which means a risk of necrosis of the femoral head. In this case placement of a hip prosthesisis necessary ;
• And the fracture is meshed (two fragments enter one into the other, editor’s note) or displaced in coxa valga (open angle, Editor’s note) – which is rarer – the risk of necrosis is lower. We will be able to keep the articulation and perform osteosynthesis (consolidation using screws, plates, etc.) even in an elderly person”, explains the surgeon.

Note: “The fractures of the trochanteric region are most often stabilized by osteosynthesis […] but can also be treated, more rarely, by a prosthesis, in certain cases, completes the French Society of Orthopedic and Traumatological Surgery (SOFCOT) (source 2).

Broken femoral neck: how long following the fracture should we operate?

This procedure should be performed ideally within 24 to 48 hourspour prevent the general condition of the patientoften weakened by other pathologies (cardiac, respiratory, etc.), is degrading. The intervention can, however, be deferred in view of the need to stop treatments that are contraindicated during surgery, such as certain oral anticoagulants.

In a young person, victim of an accident on the public highway, for example, the fracture of the neck of the femur is rare, but it does exist. In this case, the surgeon will prefer, as much as possible, to preserve the head of the femur and to avoid the installation of a prosthesis.

When do you walk once more following a femoral neck fracture?

The day following the operation, the patient is encouraged to take a few steps – with the help of canes or crutches – under the close supervision of a physiotherapist. You have to walk, but without forcing. The bone will consolidate in six weeks. The resumption of physical activity, for people who have the capacity, cannot be done before three months.

The re-education can be done at home or in a specialized center. It consists, following fitting a hip prosthesis (the most common case), of learning to walk once more and, above all, of avoiding certain positions at risk of dislocation. It lasts at least three weeks.

Why do people die of a femoral neck fracture?

This rehabilitation is essential for avoid loss of autonomy. In 2016, a study by the Ministry of Health showed that one in three men and one in five women die in the year following a femoral neck fracture. The higher the age of the patient, the more his state of health is degraded and the more the mortality risk is high. In this context, the fracture of the neck of the femur is, in a way, one accident too many; the straw that broke the camel’s back. “The mortality rate is 30% among those over 75 and 50% among those over 90, in the year following the operation,” notes Dr. Bastard. This shows the importance of prevention.

How to prevent falls in the elderly?

Given the extremely serious consequences that a fracture of the neck of the femur can have, everything must be done to avoid it. Prevention goes first and foremost through osteoporosis care. Treatments exist and they are effective. A diet rich enough in calcium, at the rate of 1 gram per day, is necessary to protect the bone. A vitamin D supplementationwhich helps calcium bind to bone, is sometimes prescribed.

The regular practice of a physical activityis strongly encouraged. It must be adapted according to the age, the capacities and the desires of each one. Exercise keeps muscles strong and bones strong. This is the best way to limit the risk of falls.

Adapting an elderly person’s home can also be very useful. To secure the accommodation, we start by removing slippery carpets and moving furniture that hinders movement.

Finally, Dr. Bastard advises reviewing certain prescriptions with your attending physician.. Some medications (the sleeping tablets for example) may have as side effects of balance disorders and dizziness. A risk of falling that can, in some cases, be avoided.

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