Femoral Neck Fractures: Recovery, Rehabilitation, and Walking Challenges

Left femoral neck fracture?

My husband unfortunately suffered a fracture of the left femoral neck on May 22 of this year, and it has been four months since then.
During his most recent follow-up appointment, the doctor mentioned that the joint has been preserved, but the bone has not yet healed.
Could you please explain what this means? He started practicing walking with his left foot on the fifth day, but he is walking with a noticeable limp.
Is it possible that his left foot will always walk this way in the future? Additionally, could you advise on what rehabilitation exercises he should do?
Furthermore, my husband mentioned that the area behind his knee feels very stiff, and he is having difficulty supporting himself while walking.
What could be the cause of this? Thank you!

Youfu de furen, 30~39 year old female. Ask Date: 2006/09/23

Dr. Li Wenlin reply Orthopedics

Hello,
In response to your question, femoral neck fractures are initially classified into two categories: one with no displacement or minimal displacement.
Cases in this category are typically treated with internal fixation (using screws or plates).
If all goes well, the probability of fracture healing is greater than 90%.
However, about 30% of all cases may develop into avascular necrosis of the femoral head over time.
Once the femoral head deforms and causes pain, total hip arthroplasty or partial hip arthroplasty must be performed.
Therefore, for non-displaced femoral neck fractures occurring in relatively younger patients, it is recommended to also harvest a piece of vascularized bone for transplantation at the fracture site during internal fixation to reduce the likelihood of future avascular necrosis of the femoral neck.
Your husband's situation likely falls into this category.
Four months post-surgery, the doctor mentioned that the joint has been preserved but the fracture has not yet healed, which likely indicates that the fracture site has not yet healed properly and there are no issues with avascular necrosis of the femoral neck.
Therefore, he should still avoid putting full weight on the affected limb and can use crutches or a single crutch to bear partial weight on the affected limb.
It is normal to have a limp while walking until the fracture is completely healed.
Rehabilitation exercises can include practicing leg raises, both forward and sideways (standing with weight on the healthy side, preferably with a wall or furniture for support, raising the affected limb at least 30 centimeters off the ground, holding for more than five seconds, then lowering it; this counts as one repetition, and aim for at least fifty repetitions when possible).

Your husband mentioned stiffness in the popliteal area, making it difficult to walk.
This is a characteristic feature of issues near the hip joint, and patients with non-healed femoral neck fractures often experience this.
There is no need for concern; generally, this sensation improves after the fracture heals.
Your concern for your husband shows the strength of your relationship.
While it’s important to care and worry, it’s also essential to collaborate closely with the attending physician, as each case has different contexts, and only the physician who understands your husband's situation best can provide the most appropriate and effective advice.
Wishing you all the best.

Reply Date: 2006/09/23

More Info

Femoral neck fractures are a common injury, particularly in older adults, and they can significantly impact mobility and quality of life. Your husband's situation, where he sustained a left femoral neck fracture on May 22 and is now four months into recovery, raises several important considerations regarding healing, rehabilitation, and walking challenges.

When the doctor mentions that the "joint has been preserved but the bone has not yet united," it indicates that while the joint surfaces are intact and functioning, the fracture itself has not healed sufficiently. Bone healing typically occurs in stages: inflammation, repair, and remodeling. In the case of a femoral neck fracture, the healing process can be prolonged, especially if there are complications such as poor blood supply to the area or if the fracture is displaced. The fact that your husband is experiencing difficulty with walking and a noticeable limp suggests that he may still be in the early stages of recovery.

Walking with a limp can be a result of several factors:
1. Pain and Discomfort: If the fracture site is still painful, it can lead to compensatory gait patterns where the individual avoids putting full weight on the affected leg.

2. Muscle Weakness: After a fracture, especially one involving the hip, the surrounding muscles (like the quadriceps, hamstrings, and hip abductors) may weaken due to disuse. This weakness can contribute to instability and difficulty in walking.

3. Joint Stiffness: As you mentioned, your husband is experiencing stiffness in the knee, which can further complicate his ability to walk normally. Stiffness can arise from immobility during recovery or from the body's natural response to injury.

To address these challenges, a comprehensive rehabilitation program is essential. Here are some recommendations for rehabilitation exercises and strategies that may help your husband regain strength and improve his walking ability:
1. Weight-Bearing Exercises: Gradually increasing weight-bearing activities is crucial. This can start with partial weight-bearing and progress to full weight-bearing as tolerated. Using assistive devices like crutches or a walker can provide support during this transition.

2. Range of Motion Exercises: Gentle stretching and range of motion exercises for the hip and knee can help alleviate stiffness. These should be performed within a pain-free range and can include:
- Heel slides
- Ankle pumps
- Hip flexion and extension exercises
3. Strengthening Exercises: Once the doctor approves, strengthening exercises can be introduced. Focus on the major muscle groups around the hip and knee, such as:
- Straight leg raises
- Gluteal squeezes
- Side-lying leg lifts
- Mini squats (if tolerated)
4. Balance and Gait Training: Working with a physical therapist on balance exercises can help improve stability and confidence while walking. Gait training can also be beneficial to correct any compensatory patterns.

5. Manual Therapy: Techniques such as massage or joint mobilization performed by a physical therapist can help reduce stiffness and improve mobility.

6. Hydrotherapy: If available, aquatic therapy can provide a low-impact environment for rehabilitation, allowing for greater movement without the stress of weight-bearing.

7. Regular Follow-Up: Continuous communication with the healthcare provider is essential. Regular follow-ups can help monitor the healing process and adjust the rehabilitation program as needed.

In summary, while your husband may experience some challenges in walking due to his femoral neck fracture, a structured rehabilitation program focusing on weight-bearing, strengthening, and mobility exercises can significantly improve his recovery. It is important to work closely with healthcare professionals to tailor a rehabilitation plan that meets his specific needs and to ensure that he progresses safely. With time and appropriate therapy, many individuals can regain their mobility and return to their daily activities.

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