Dr. M.J. Bazos, MD Patient Handout


About Your Diagnosis

A femoral neck fracture is a break of the thigh bone at the hip. This may be caused by a severe fall or an auto accident in younger individuals, but it is much more commonly seen in older individuals, particularly women. A femoral neck fracture usually results from osteoporosis or thinning of the bone associated with increasing age. If the bone of the hip is thin enough, even twisting can result in a break. Indeed, in many elderly individuals, they may twist while standing, which causes the break, and then they fall. As many as one fourth of all women older than 75 years may have severe enough osteoporosis to experience a hip fracture. Hip fractures are diagnosed by physical examination and an x-ray. Many individuals have a complete recovery
after surgery.

Living With Your Diagnosis
The symptoms of a hip fracture are pain in the hip, buttock, or pubic area, especially with movement of the hip or leg. A frequently seen sign is shortening of the affected leg when compared with the other leg. In addition, the foot of the affected leg will frequently turn in. A later sign may be bruising on the hip, especially in thin individuals.

Treatment is nearly always surgical. There are a variety of surgical options depending on where the hip fracture is located and on the condition of the bone. These range from placing pins across the fracture to using metal plates and screws to hold the bone fragments together. Other choices include replacing the ball of the hip joint with a metal one, or replacing the socket as well as the ball. At times, if the patient is in very poor health and cannot tolerate surgery, the treatment may be bed rest to try to allow the fracture to heal. This has a very poor success rate with many complications and is reserved for individuals who simply cannot tolerate surgery. The main side effects of surgery are those seen with any surgery: namely, infection and bleeding. Sometimes, the surgery fails to stabilize the joint, usually because the remaining bone is too thin for the artificial joint or the screws or pins to hold.
The DOs
Your doctor will prescribe medications for pain. After most of the surgeries done now, a physical therapy program is started, which will have the patient out of bed within a few days after surgery. This is important to prevent weakening of the muscles. Pain medicines will make this more comfortable and should be used appropriately to speed recovery. An adequate diet to provide protein and calcium will speed healing of the bone. Exercise in the form of physical therapy is a crucial part of recovery from surgery. Most individuals will achieve a total recovery if they are diligent in the physical therapy regimen. The prevention of hip fractures is crucial. It is possible to slow or even reverse osteoporosis with appropriate diet, exercise, and medical therapy, including hormone replacement therapy (estrogen) for women who have gone through menopause. The stronger the bone, the less likely you are to sustain a hip fracture. If osteoporosis is present, there are medicines that may help reverse the process. You should discuss this with your doctor. In addition, there are things to do in the home that will decrease the chance of falls. These include adequate lighting and avoiding tripping hazards such as loose rugs and poor-fitting shoes. Many home health agencies can offer help in making the home safer.

The DON’Ts
Medications that have side effects of dizziness or drowsiness may increase the risk of falls. Medicines such as steroids, thyroid medicines, and diuretics may increase osteoporosis and should only be used if the benefits outweigh the risks of osteoporosis. Alcohol and tobacco use increase the risk of osteoporosis, as does lack of weight-bearing exercise. A diet low in calcium and excessive in protein increases risk. A living environment with poor light and lots of tripping hazards increase the risk of a fall. The most significant long-term adverse effects of hip fractures have been pneumonia or blood clots to the lungs because of prolonged bed rest. Indeed, this is largely why the outcome of nonsurgical treatment is poor. With advances in surgical techniques that allow ambulation to start within a few days after surgery, these adverse effects have decreased. However, failure to comply with a physical therapy program, as well as prolonged bed rest, will increase these risks.

When to Call Your Doctor
You should call your doctor if you have any increasing pain in your hip after surgery. This could be a sign of infection, bleeding, or loosening of the hip replacement or screws. You should also call if you are having increasing difficulty walking, because this also can be a sign of loosening of the hip replacement. You should also call when signs of infection are present, such as fever, or swelling or redness of the incision line. Any shortness of breath and coughing should be reported to your doctor because they could be signs of pneumonia or a blood clot to the lungs, which can be complications of a hip fracture.

Description of fractures and of surgical repairs: http://www.medmedia.com/oo4/156.htm
Description of surgery and recovery: http://www.depuy.com/PatientEd/Hip/Hip.htm
Information on osteoporosis: http://www.oznet.ksu.edu/dp_fnut/NUTLINK/pages/bones.htm