General
- Accounts for approximately 2.5-9% of femoral fractures
- Frequently occurs in polytrauma
- Femoral neck fractures may be missed initially in 19-31% of cases
- The neck fracture is commonly basicervical (63-89%)
- Major concerns:
- AVN
- Nonunion
- Malunion
- Rotational deformity
- Limb shortening
Treatment Options
1. Reconstruction/cephalomedullary nail
- Single implant for both fractures
- Biological fixation with smaller incisions
- Potentially less blood loss
- Disadvantages:
- Technically demanding, particularly with a displaced neck fractures (Further reading)
- Risk of varus malreduction, rotational malalignment, or inadequate neck fixation
2. Plate + screw/DHS fixation
- Separate fixation of neck and shaft
- Technically easier in many cases
- Allows direct control of the neck fracture
- More extensive exposure and potentially greater soft-tissue disruption
Other strategies include:
- Antegrade shaft nail + separate neck screws (Miss-a-nail technique)
- Retrograde nail + neck screw fixation
- Various combined plate constructs
Which Fracture First?
For a displaced femoral neck fracture, reduction and temporary stabilization with guidewires can prevent further displacement.
A practical sequence is:
- Step 1: Reduction and temporary stabilization of neck
- Step 2: Reduction and fixation of shaft
- Step 3: Definitive neck fixation
Stabilizing the shaft can facilitate reduction of the displaced neck fracture and help avoid rotational malalignment.
Timing
Unlike an isolated femoral neck fracture, immediate emergency fixation of the neck may not always be necessary in this combined injury pattern.
In polytrauma patients, surgery may be delayed according to the patient’s overall condition.
The case series reported that a 5–6 day delay in fixation did not appear to increase AVN or adversely affect functional outcome.
Treatment Goals
- Anatomic reduction of femoral neck fracture
- Stable fixation of both femoral neck and shaft fractures
- Early mobilization
References and further reading:
- Singh R, Rohilla R, Magu NK, Siwach R, Kadian V, Sangwan SS. Ipsilateral femoral neck and shaft fractures: a retrospective analysis of two treatment methods. J Orthop Traumatol. 2008 Sep;9(3):141-7. doi: 10.1007/s10195-008-0025-3. Epub 2008 Aug 7. PMID: 19384610; PMCID: PMC2656981.
He is the section editor of Orthopedics in Epomedicine. He searches for and share simpler ways to make complicated medical topics simple. He also loves writing poetry, listening and playing music. He is currently pursuing Fellowship in Hip, Pelvi-acetabulum and Arthroplasty at B&B Hospital.
