Left Femoral Neck Fractures: Surgery, Recovery, and Pain Management

Left femoral neck fracture?

Hello, doctor.
I had a car accident on February 2nd of this year, which resulted in a fracture of my left femoral neck.
I had three screws inserted.
The doctor mentioned that the screws can be removed or left in place, and I would like to know if there is a recommendation for removal.
I am currently still experiencing pain when pressing on the area; is this normal? Would removing the screws help alleviate the pain? On December 6th, the doctor reviewed my X-rays and indicated that the fracture has healed, but the decision to remove the screws is up to me.
If I decide to have them removed, is it better to wait a full year before doing so? Additionally, what is the typical recovery period before I can bear weight after the surgery?

Xiao Bin, 20~29 year old female. Ask Date: 2021/12/17

Dr. Shi Guozheng reply Orthopedics

Femoral neck fractures are typically stabilized with three bone screws, which can usually be removed after more than a year.
Leaving the screws in the hip may cause a tingling sensation.
Screw removal usually requires about a week of rest.

Reply Date: 2021/12/17

More Info

Understanding left femoral neck fractures, particularly in the context of surgical intervention, recovery, and pain management, is crucial for patients who have experienced such injuries. A femoral neck fracture is a common injury, especially in older adults or those involved in high-impact accidents, such as car crashes. In your case, the insertion of three screws indicates that surgical fixation was performed to stabilize the fracture and promote healing.

Surgical Considerations
The decision to remove the screws after a femoral neck fracture is often based on several factors, including the patient's age, activity level, and the presence of any ongoing symptoms. In many cases, if the screws are not causing any discomfort or complications, they can remain in place indefinitely. However, if you are experiencing persistent pain, it may be worth discussing the possibility of removal with your orthopedic surgeon.

Pain Management
It is not uncommon to experience pain following a femoral neck fracture, even after the fracture has healed. This pain can be attributed to several factors, including:
- Soft Tissue Healing: Surrounding muscles, tendons, and ligaments may still be healing, which can cause discomfort.

- Screw Irritation: The presence of screws can sometimes irritate surrounding tissues, leading to pain.

- Post-Traumatic Arthritis: In some cases, the injury can lead to early onset arthritis in the hip joint, which can cause chronic pain.

Recovery Timeline
Typically, the recovery period after a femoral neck fracture can vary significantly based on the severity of the fracture, the surgical technique used, and the individual’s overall health. Generally, patients are advised to avoid weight-bearing activities for about 6 to 12 weeks post-surgery, depending on the stability of the fracture and the surgeon's recommendations.

Weight Bearing and Rehabilitation
After the initial healing phase, a gradual return to weight-bearing activities is usually encouraged. Physical therapy plays a critical role in this process, helping to restore strength, flexibility, and function to the hip joint. The timeline for returning to full weight-bearing activities can vary, but many patients can expect to start partial weight-bearing around 6 weeks post-surgery, progressing to full weight-bearing by 12 weeks, provided there are no complications.

Recommendations for Screw Removal
If your orthopedic surgeon has indicated that the fracture has healed and you are still experiencing pain, it may be beneficial to discuss the option of screw removal. While some surgeons recommend waiting a year before removal to allow for complete healing, others may consider earlier removal if the screws are causing significant discomfort.

Conclusion
In summary, while it is normal to experience some pain after a femoral neck fracture, persistent pain warrants further evaluation. Discussing your symptoms with your orthopedic surgeon is essential to determine the best course of action, whether that involves pain management strategies, physical therapy, or the potential removal of the screws. Always follow your surgeon's advice regarding weight-bearing activities and rehabilitation to ensure a safe and effective recovery.

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