Femoral Neck Fracture

The femoral neck is the angled section of bone that connects the ball at the top of your thigh bone to the long shaft below. Breaks here — commonly called hip fractures — are among the most common and most serious orthopedic injuries. Two patient groups: older adults with osteoporosis, whose weakened bone can break from a relatively minor fall, and younger active patients whose normal bone breaks from high-energy trauma or repetitive stress.

In older adults, hip fractures carry serious risks — 20 to 30 percent of elderly patients die within a year of the injury, mostly from complications of being immobile. The standard of care is to operate within 24 to 48 hours: the goal is to get you up and moving as soon as possible, because the dangers of prolonged bed rest (pneumonia, blood clots, pressure sores, deconditioning) outweigh the risks of surgery for almost everyone.

When the fracture shifts (displaces), the picture is unmistakable: severe groin pain, you can't put any weight on the leg, and the affected leg looks shorter and rotated outward compared to the other side. That outward rotation happens because the muscles around the hip pull the leg into that position once the bone is no longer holding them in check.

A non-displaced fracture is subtler — you may have groin pain but still be able to hobble around, which is why these fractures are sometimes missed on the first visit. Pain with any attempt to roll the hip inward or outward (the log-roll test) is a reliable sign. Bruising around the hip can take a day or more to appear.

A shifted (displaced) fracture is unmistakable: groin pain, can't bear weight, the affected leg looks shorter and rotated outward. A non-shifted fracture may only cause groin pain — easy to miss. Standard pelvis and hip X-rays confirm most fractures. A CT or MRI is added when a non-displaced fracture or a stress fracture is suspected but not visible on plain X-ray.

The vast majority of femoral neck fractures need surgery. The choice between fixation (screws or plates that hold the original bone together) and replacement (removing the broken section and inserting a new ball — a hip replacement) depends on how far the fracture has shifted, the patient's age and bone quality, and whether the blood supply to the ball is still intact. Younger patients tend to get fixation when possible to preserve the natural joint; older patients more often get replacement.

External patient-education references and related OSI pages for additional background:

• Britannica — Bone disease (fractures)
• Britannica — Hip (anatomy)
• AAOS OrthoInfo — patient education library
• OSI glossary — orthopedic terminology in plain language