Femoral Neck Fracture

　　A fracture between the subcapital femoral head and the base of the femoral neck is called a femoral neck fracture, which is one of the common fractures in the elderly, especially more common in elderly women. Most femoral neck fractures are spiral or oblique fractures caused by external rotational force. Depending on the posture of injury, the direction and degree of external force, different locations, angles, and displacements appear on X-ray projections. Femoral neck fractures can be divided into four types, which are closely related to treatment and prognosis.

　　Two basic factors contribute to femoral neck fractures in the elderly: the decrease in bone strength and the degeneration of the hip circumflex muscle group, which cannot effectively counteract the harmful stresses around the hip. In young adults, femoral neck fractures are often caused by severe injury. Additionally, the blood supply condition of the femoral head is also one of the causes of non-union of the fracture and femoral head necrosis.

　　The femoral head is surrounded by articular cartilage, and its blood supply mainly comes from the circumflex internal femoral artery, with a small part coming from the circumflex external femoral artery. Both form an arterial ring outside the joint capsule. This arterial ring gives rise to four groups of ascending neck arteries that enter the joint capsule, forming an intracapsular arterial ring at the edge of the cartilage and the surface of the femoral neck, and finally supply blood to the femoral head. Femoral neck fractures often destroy the ascending neck arteries, causing interruption of blood supply to the femoral head, leading to non-union of the fracture and femoral head necrosis.

　　Bones are relatively fragile parts of the human body, especially for the middle-aged and elderly, who are very prone to fractures. Femoral neck fracture is one of the common fractures. Experts remind that it is necessary to be vigilant about the complications of femoral neck fracture after the injury. Below, the editor will introduce the complications of femoral neck fracture, hoping everyone will be cautious and vigilant. Below, we will introduce the complications of femoral neck fracture.

　　1. Joint Stiffness

　　To ensure that the bones grow in the normal position after a femoral neck fracture, some patients often restrict the movement of the affected joint, which can easily lead to adhesions between muscles, tendons, and ligaments, thereby causing the joint to become stiff. Therefore, while the patient is immobilized with plaster or splints, it is important to allow the movement of joints that are not restricted to ensure blood circulation. In addition, appropriate contraction and relaxation exercises should be performed on the muscles of the immobilized area to prevent muscle contracture.

　　2. Atelectasis

　　Some patients with femoral neck fractures may develop atelectasis due to prolonged bed rest, which restricts lung expansion and causes poor expectoration of sputum. As a result,坠积性肺炎 may occur. Therefore, fracture patients should maintain fresh indoor air, prevent catching a cold, and frequently change positions and perform deep breathing exercises. Those who have a smoking habit should try to quit smoking during this period. When sputum is difficult to cough up, gently tapping the patient's back can help expel the sputum.

　　3. Growth Disorders

　　As the growth of children's bones mainly depends on the continuous ossification of epiphyseal cartilage, it is possible for children to experience slow bone growth or deformity after a fracture of the femoral neck. After such deformity occurs, patients generally require surgical correction.

　　4, Traumatic arthritis

　　When the femoral neck fracture patients have poor reduction or are not treated, the fracture site will cause malunion, which not only makes the appearance ugly, but also due to the change of force direction when bearing weight, it is easy to cause excessive wear, degeneration, hyperplasia and other pathological changes in the joint of the deformed site, forming traumatic arthritis. In order to prevent the occurrence of traumatic arthritis, the fracture patients should receive correct treatment as soon as possible. For patients with severe deformity, surgery can be performed for correction.

　　Through the above introduction, I believe that you have a certain understanding of the complications and causes of femoral neck fractures. If there is a femoral neck fracture, it needs to be treated actively and prevented from necrosis of the femoral head.

　　What are the main symptoms of femoral neck fractures? The experts of the orthopedic hospital have given a detailed explanation, hoping to provide help to patients who are suffering from the disease! The specific symptoms of femoral neck fractures are as follows:

　　1, Pain:

　　In addition to spontaneous pain in the hip, pain is more obvious when moving the affected limb. When tapping the heel of the affected limb or the greater trochanter, pain is also felt in the hip. There is often tenderness below the midpoint of the inguinal ligament.

　　2, Swelling:

　　Most femoral neck fractures are intra-articular fractures. After the fracture, there is not much bleeding, and there is also the surrounding joint capsule and abundant muscle groups. Therefore, it is not easy to see local swelling in appearance. This is one of the symptoms of femoral neck fractures.

　　3, Deformity:

　　The affected limb often has mild flexion of the hip and knee and external rotation deformity.

　　4, Dysfunction:

　　Patients with displaced fractures cannot sit up or stand after the injury. This is one of the symptoms of femoral neck fractures. However, some patients with non-displaced linear fractures or comminuted fractures can still walk or ride a bicycle after the injury.

　　5, Shortening of the affected limb:

　　In displaced fractures, the distal segment is pulled upwards by the muscle groups, resulting in shortening of the affected limb. This is also a common symptom of femoral neck fractures.

　　The above are the symptoms of femoral neck fractures. Orthopedic diseases are a common and frequent disease that people often encounter. A positive attitude should be adopted to face this disease, and active cooperation with the doctor's medication should be ensured.

　　The femur is also known as the thigh bone, with a spherical head at the upper end, forming the hip joint with the acetabulum of the hip bone. The movement of the thigh relies on this joint. Below the head of the femur, there is a slender femoral neck, which connects the head of the femur with the shaft of the femur. In the entire femur, the neck of the femur is the thinnest and weakest part, and it is also a common site of fracture. Therefore, attention should be paid to the prevention of femoral neck fractures in daily life. What are the preventive methods? Let's take a look below.

　　Fractures of the femoral neck are more common in middle-aged and elderly people, especially in elderly women, mainly related to osteoporosis and brittle bones in the elderly. Most patients only have minor injuries, such as slipping while walking or sudden twisting of the thigh, which can cause a fracture. Fractures of the femoral neck are rare in young and middle-aged adults, and most fractures are caused by strong external forces, such as vehicle collisions or falls from a height.

　　At present, there is no effective preventive measure for this disease. The focus of prevention is to prevent the occurrence of complications. It mainly advocates early non-invasive reduction. Follow the early non-invasive anatomical reduction, choose reasonable and effective internal fixation materials and methods, reduce local blood supply damage, improve blood perfusion, promote early union of fractures, and restore and establish blood vessels across the fracture line to quickly participate in the repair of necrotic bone, thus avoiding the occurrence of avascular necrosis of the femoral head.

　　The final diagnosis of femoral neck fracture requires hip anteroposterior and lateral X-ray examination, which is particularly important for linear fractures or impacted fractures. X-ray examination is also indispensable as a reference for fracture classification and treatment. It should be noted that some non-displaced fractures may not show fracture lines on X-ray films taken immediately after injury. CT or MRI can be performed at that time, or wait for 2-3 weeks, as some bone tissue at the fracture site has been absorbed, and the fracture line is clearly displayed. Therefore, for those suspected of having femoral neck fracture in clinical practice, even if the fracture line is not visible on the X-ray film, it should be treated as an impacted fracture, and the film should be re-examined after 3 weeks. Another easily missed situation is multiple injuries, which often occur in young people. Due to obvious injuries such as femoral shaft fracture, femoral neck fracture is often concealed, so for this kind of patient, attention should be paid to hip examination.

　　The femoral neck is located between the femoral head and the femoral neck, which is the anatomical segment that bears the greatest shearing force in the human body. Femoral neck fractures often occur in the elderly due to osteoporosis, fragility of the femoral neck, and fracture can occur with a slight fall. The blood supply to this area is poor. If the fracture is not treated promptly or appropriately, it can lead to non-union of the fracture or complications such as avascular necrosis of the femoral head, traumatic arthritis, which seriously affects the elderly's quality of life. The following introduces the dietary taboo for femoral neck fracture patients.

　　1. Dietary requirements for the early stage of neck fracture

　　The principle of dietary coordination is to focus on light and healthy foods, such as vegetables, eggs, dairy products, fruits, fish soup, lean meat, etc.

　　2. Dietary requirements for the middle stage of neck fracture

　　It is suitable to eat bone soup, Panax notoginseng chicken stew, animal liver

　　3. Dietary requirements for the later stage of neck fracture

　　It is suitable to eat old hen soup, pork bone soup, sheep bone soup, deer tendons soup, braised water fish, etc. Those who can drink can choose Du Zhong broken bone wine, chicken blood vine wine, tiger bone papaya wine, etc.

　　4. Early dietary requirements for neck fracture should avoid sour and spicy, dry and hot, and greasy things

      It is particularly not advisable to take greasy and nourishing foods prematurely, such as bone soup, fatty chicken, braised water fish, etc. In addition, fruit juice and sugar are also not suitable.

　　The above is the dietary requirements for femoral neck fracture, hoping to provide some help to the patients with this disease. If there is a femoral neck fracture, it is necessary to receive active treatment and actively prevent avascular necrosis of the femoral head. If avascular necrosis of the femoral head occurs, artificial hip replacement surgery can be considered.

　　Before selecting the treatment method for femoral neck fracture, it is essential to understand the patient's overall condition, especially for the elderly, who need a comprehensive examination, including blood pressure, heart, lung, liver, and kidney functions, and a comprehensive consideration of the fracture.

　　The healing of femoral neck fracture is slow, on average it takes 5 to 6 months, and the non-union rate is relatively high, averaging about 15%. Factors affecting fracture healing are related to age, fracture location, fracture type, degree of fracture and displacement, reduction quality, and the strength of internal fixation.

　　1. General treatment methods

　　1. External fixation:

　　It is suitable for extrusion and intermediate type fractures. Generally, the affected limb is traction or anti-foot external rotation shoe for 8 to 12 weeks, to prevent external rotation and internal retraction of the affected limb. It takes about 3 to 4 months to heal, and non-union or femoral head necrosis occurs very rarely. However, there is a possibility of malalignment in the early stage of fracture, so some people advocate using internal fixation as a better choice. As for plaster external fixation, it is rarely used and is limited to smaller children. Internal fixation has the widest indications.

　　2. Internal fixation:

　　Currently, hospitals with conditions use closed reduction internal fixation with the assistance of a fluoroscope, and if there is no fluoroscope equipment, open reduction internal fixation can also be used. Before internal fixation surgery, manual reduction is performed first to confirm anatomical reduction of the fracture ends before proceeding with internal fixation surgery. There are many types of internal fixation, and there are approximately the following types in summary:

　　① Smith-Petersen three-blade nail internal fixation:

　　Since Smith-Petersen first used the three-blade nail in 1929, the efficacy of femoral neck fracture treatment has significantly improved, and it is still one of the commonly used internal fixation methods to this day.

　　② Sliding internal fixation:

　　There are various types of compression nails or needles available. Compression nails or needles can slide in the sleeve. When there is absorption on both sides of the fracture line, the nail slides into the sleeve to shorten and maintain close contact between the fracture ends, which is more conducive to the interlocking of the fracture ends in the early stage of weight-bearing.

　　③ Pressurized internal fixation:

　　This type of internal fixation device has a compression device, which can make the fracture ends interlock with each other to facilitate healing. Commonly used are Charnley's spring-loaded compression screws and Siffert's screw bolts (Corkscrew Bolt) and so on.

　　④ Multi-needle (or nail) internal fixation:

　　According to the bone structure and biomechanical principles of the upper end of the femur, 2 to 4 screws or steel pins are inserted respectively, which not only fixes securely but also reduces the damage to the femoral head. Such as Moore or Hagia needles, etc. In summary, there are many types of internal fixation.

　　3. Internal fixation and bone grafting at the same time:

　　For fractures that are difficult to heal or old fractures, in order to promote their healing, bone grafting is performed at the same time as internal fixation. There are two methods of bone grafting:

　　① Free bone grafting:

　　For example, inserting the fibula or tibia strip into the femoral head from below the greater trochanter, or using cancellous bone to fill bone defects, etc.

　　② Pedicle bone grafting:

　　The most commonly used is the sartorius muscle pedicle bone flap bone grafting. With the progress of microsurgical technology, vascular pedicle bone grafting has been carried out. Such as the osteotransplantation of the iliac circumflex artery bone flap.

　　4. Osteotomy:

　　For difficult healing or some old fractures, osteotomy can be selectively performed, such as intertrochanteric osteotomy or subtrochanteric osteotomy. Osteotomy has the advantages of easy surgical operation, less limb shortening, and is conducive to fracture healing and functional recovery.

　　5. Artificial Joint Replacement:

　　It is suitable for elderly patients with subcapital femoral neck fracture. For old femoral neck fracture, non-union of fracture, or ischemic necrosis of the femoral head, if the lesion is localized in the head or neck, hip joint replacement surgery can be performed, if the lesion has damaged the acetabulum, total hip replacement surgery is required. Currently less commonly used artificial hip joint types include cobalt alloy pearl surface artificial femoral head, nitrogen-titanium alloy micro-porous surface artificial femoral head, double-center locking ring artificial femoral head, etc., and the acetabular damage is replaced with high molecular weight polyethylene acetabulum, and good clinical effects have been achieved in clinical applications.

　　Second, conservative treatment

　　First, artificial hip joint replacement surgery: try not to use surgery as much as possible and minimize the damage to the damaged area.

　　Second, early activity and early functional exercise promote blood circulation and reduce joint stiffness.

　　Third, through drug expansion of the remaining capillaries and repair of damaged capillaries, promote blood supply, ensure that the effective components of the drug reach the lesion site.

　　Comprehensive treatment through three aspects has significant efficacy, and from long-term clinical observation, the earlier the femoral neck fracture is treated according to Chenglin therapy, the better the effect.

　　Three, Treatment Points

　　1. Non-surgical Treatment: Fresh non-displaced stable external rotation type fractures, use skin traction or wear a crutch shoe.

　　2. Open Reduction and Internal Fixation.

　　3. Drug Treatment:

　　Take oral bone-setting decoction once a day, one bottle (50ml) per time, for 48-72 bottles consecutively, or use Bruise and Fracture Treatment Granules, once in the morning and once in the evening, one packet (10g) per time, for 160-240 packets consecutively; if it is the neck type, take oral bone-setting decoction once a day, one bottle (50ml) per time, for 72-96 bottles consecutively, or use Bruise and Fracture Treatment Granules, once in the morning and once in the evening, one packet (10g) per time, for 240-320 packets consecutively.

　　4. After taking oral medication,配合足背伸运动, 3000-5000 times a day, and according to the condition, do bed support- cane support- cane-free walking exercises for 10 minutes-2 hours a day.

　　The above is the treatment method for femoral neck fracture, hoping to provide help to patients. The specific quality plan for femoral neck fracture needs to be decided by doctors based on the actual condition of the patient.