bubble_chart Overview

Femoral neck fractures commonly occur in the elderly, and with increasing life expectancy, their incidence is gradually rising. The clinical treatment of these fractures faces two major issues: non-union of the fracture and avascular necrosis of the femoral head.

bubble_chart Etiology

There are two fundamental factors contributing to fractures in the elderly: one is the decline in bone strength, and the other is the degeneration of the hip muscles in older adults, which cannot effectively counteract harmful stresses on the hip. In contrast, femoral neck fractures in young adults are often caused by severe injuries.

bubble_chart Clinical Manifestations

(1) Deformity The affected limb often exhibits grade I hip and knee flexion and external rotation deformity.

(2) Pain Hip pain is significant when moving the affected limb. Pain is felt in the hip when tapping the heel or greater trochanter of the affected limb.

(3) Functional Impairment Individuals with a displaced fracture are unable to sit up or stand after the injury.

bubble_chart Diagnosis

Obvious history of trauma, pain in the affected limb, and limited movement. X-rays can determine the location and displacement of the fracture.

bubble_chart Treatment Measures

(1) Timing of Treatment Early treatment is beneficial for the rapid recovery of vascular compression or spasm after a fracture. In principle, surgery for a femoral neck fracture should not exceed two weeks.

(2) Accurate Reduction of Fracture Good reduction is an important condition for bone healing.

Traction is applied to the affected limb while counter-traction is added at the root of the thigh. Once the original length of the limb is restored, internal rotation and abduction reduction are performed.

(3) Internal Fixation Currently, internal fixation devices are mainly divided into four categories:

① Single Nail Type: Represented by the triflange nail, the three-blade nail internal fixation is a well-known traditional therapy. This single nail does not provide lasting mechanical efficiency in the bone and is also not suitable for adolescents and those with comminuted neck fractures.

② Multi-Nail Fixation Type: Includes Smith-Petersen pins, triangular pins, and multiple threaded screws. This type of fixation causes less injury to the bone and utilizes the biomechanical advantages of multiple nails for better efficacy. The drawback is that the bone may not heal after the nails are removed.

③ Sliding Nail Plate Fixation Device Type: The advantage of this internal fixation device is that it can firmly embed the fracture fragments, aiding early weight-bearing. However, the operation is difficult and the surgical trauma is significant.

④ Compression Internal Fixation Type: The internal fixation nails used have threads, such as cross screws, threaded bone round pins, and spring compression screws.

(4) Selection of Treatment Methods The treatment of fresh femoral neck fractures mainly depends on the location of the fracture.

① Basal Femoral Neck Fracture: Incomplete fractures and impacted abduction fractures can be treated with skin traction or bone traction.

② Mid-Shaft Femoral Neck Fracture: Single nail, multiple pins, or compression internal fixation can be performed.

③ Subcapital Femoral Neck Fracture: These are difficult to heal and often result in necrosis. For patients over 65 years old, artificial joint replacement is often performed. For those below this age, multiple pins or compression nail internal fixation is preferred.

④ Pediatric Femoral Neck Fracture: The main blood supply to the pediatric femoral neck comes from the intramedullary stirred pulse. Four 2mm Kirschner wires are used for percutaneous pinning internal fixation, causing less injury. Postoperatively, a hip spica cast is applied for 12 weeks, and close observation is required for any signs of femoral head necrosis.

⑤ Quadratus Femoris Muscle Pedicle Bone Graft: Preoperatively, tibial tubercle bone traction is performed for one week to relax the contracted hip muscles and correct the fracture displacement. The femoral neck and head are exposed during surgery, the fracture is reduced, and a bone groove is chiseled along the long axis of the femoral neck. The bone flap with the quadratus femoris muscle pedicle is embedded in the bone groove of the femoral neck, and compression nails or multiple pins are inserted under direct vision below the greater trochanter of the femur.

⑥ Deep Circumflex Iliac Artery Pedicle Iliac Bone Flap Transfer for Femoral Neck Fracture: This can be used for fresh femoral neck fractures in young adults.

The femoral stirred pulse is exposed during surgery, and the deep circumflex iliac vessels are directly located in the inguinal ligament leukorrheal disease. A 6.0cm×1.5cm×1.5cm full-thickness bone block is designed around this vascular bundle, wrapped in saline gauze, and kept for use.

Artificial Femoral Head Replacement: For patients over 65-70 years old with fresh subcapital or comminuted femoral neck fractures with displacement, old fractures that have not healed, or femoral head necrosis without acetabular osteoarthritis, artificial femoral head replacement surgery can be performed.