Jonathan Cluett, MD, is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery.

Stuart Hershman, MD, is a board-certified spine surgeon. He specializes in spinal deformity and complex spinal reconstruction.

A femoral neck fracture is a type of hip fracture of the thigh bone (femur)—just below the ball of the ball-and-socket hip joint. This type of fracture disconnects the ball from the rest of the femur. It often causes groin pain that worsens when you putting weight on the injured leg.

Hip fractures are more common among the elderly, but they can occur occasionally in active younger people due to falls, auto accidents, and occasionally, stress fractures related to overuse. Immediate treatment of a femoral neck fracture—or any hip fracture, for that matter—is essential to mitigating possible complications.

Mobility and quality of life are important factors when considering the impact of any hip fracture. Severe osteoarthritis can result after this type of fracture. Hip fractures are particularly dangerous for older adults.

Among the elderly, the risk of death rises dramatically after sustaining such an injury. Overall mortality rates hover at 6% during hospital treatment and 20 to 30% during the first year after injury (with highest rates during the first six months). Mortality can occur due to immediate complications like infection, or to delayed complications due to lack-of-mobility—such as pneumonia and cardiovascular disease. 

Prompt treatment of a hip fracture is crucial. Some research has shown the mortality and complication rates in elderly fracture patients can be better when surgery is done within 48 hours. 

Femoral neck fractures can be complicated because the bone in that area is thin. And osteoporosis is often a contributing factor. In addition, the blood supply to the fractured portion of bone can be damaged at the time of injury, which impedes bone healing.

Disrupted blood flow to bone often results in osteonecrosis, a condition in which the bone cells die due to a lack of blood flow. This can lead to bone collapse in the area of injury.

Your healthcare provider can usually diagnose a femoral neck fracture with a hip X-ray. In some cases, such as with a stress fracture, you might have symptoms, but your X-ray might not show significant findings. The fracture would likely be visible with computerized tomography (CT) scan, magnetic resonance imaging (MRI), or a bone scan.

The Garden classification system is used to rate the severity of a femoral neck fracture. There are four stages, or types, with type I being the least severe (an incomplete, non-displaced fracture; a partial break) and type IV being the most severe (a complete, fully-displaced fracture; bones are separated and out of alignment).

This classification is used by your medical team as they consider the most effective course of treatment for your fracture.

Surgery is the most common treatment for a femoral neck fracture, though conservative management could be the best approach for you if surgery would be a very high risk for you or if you have a less-severe stress fracture.

Conservative treatments could include resting your hip joint, keeping weight off your hip with crutches, pain management, and physical therapy after the bone has healed.

For surgical treatment, the most important criteria include:

During your surgery, your surgeon would manually re-align your displaced bone and use surgical pins, screws, or nails to hold your bones in place while they heal.

There are several factors that determine whether you can place weight on your repaired hip. Check with your surgeon before initiating any therapy or exercise. As your bones heal, your pain should generally improve.

If you develop osteonecrosis, you may eventually need to have hip replacement surgery.

In hemiarthroplasty (partial hip replacement) or total arthroplasty, the bones of the ball-and-socket joint are removed and replaced with metal or ceramic implants. Hip replacement may be favored if you've had a displaced fracture because of the complications and healing rates associated with surgical repair of these types of fractures.

However, in younger patients, surgeons will make an effort to avoid a partial hip replacement, if possible. Hip replacements work very well for less active patients, but they tend to wear out in younger, more active patients. Some data shows that other surgical options work better in these individuals. 

Rehabilitation typically begins immediately after a partial or full hip replacement. Many patients can progress quickly to walking with their full weight on the implant as their pain improves.

Morrissey N, Iliopoulos E, Osmani AW, Newman K. Neck of femur fractures in the elderly: Does every hour to surgery count?. Injury. 2017;48(6):1155-1158. doi:10.1016/j.injury.2017.03.007

Morrissey N, Iliopoulos E, Osmani AW, Newman K. Neck of femur fractures in the elderly: Does every hour to surgery count?

Injury. 2017 Jun;48(6):1155-1158. doi: 10.1016/j.injury.2017.03.007. Epub 2017 Mar 6. PMID: 28325670

Hu X, Liu BJ, Wen XM, Zheng YH, Jia K. [Clinical observation of closed reduction and compression cannulated screw fixation for the treatment of femoral neck fracture in young and middle-aged patients]. Zhongguo Gu Shang. 2018 Feb 25;31(2):111-114. Chinese. doi: 10.3969/j.issn.1003-0034.2018.02.003. PMID: 29536678.

Hu X, Liu BJ, Wen XM, Zheng YH, Jia K. Clinical observation of closed reduction and compression cannulated screw fixation for the treatment of femoral neck fracture in young and middle-aged patients. Zhongguo Gu Shang. 2018;31(2):111-114. doi:10.3969/j.issn.1003-0034.2018.02.003

Kazley J, Bagchi K. Femoral Neck Fractures. [Updated 2019 Mar 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-.

Lespasio MJ, Sodhi N, Mont MA. Osteonecrosis of the Hip: A Primer. Perm J. 2019;23 doi:10.7812/TPP/18-100

Xu, D., Bi, F., Ma, C. et al. A systematic review of undisplaced femoral neck fracture treatments for patients over 65 years of age, with a focus on union rates and avascular necrosis. J Orthop Surg Res 12, 28 (2017) doi:10.1186/s13018-017-0528-9

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