Femoral neck fracture fixation (ORIF or hemiarthroplasty)

Overview

The femoral neck is the segment of bone between the femoral head and the upper shaft of the femur. A fracture here disrupts the blood supply to the femoral head, which puts the head at risk for avascular necrosis and nonunion. This risk rises sharply with displacement.

In younger patients and in non-displaced fractures, cannulated screws or a hip-screw-and-plate construct preserves the natural femoral head. In older or lower-demand patients with displaced fractures, a partial hip replacement (hemiarthroplasty) is usually more reliable. These fractures are typically treated urgently to minimize complications.

Why it's done

Femoral neck fracture fixation is typically considered when imaging and the clinical picture together indicate that the fracture will not reliably heal or function without surgical stabilization. Common indications include:

1. Displaced fracture in an older patient

   Hemiarthroplasty avoids the high nonunion and avascular necrosis rates of attempted fixation.

2. Non-displaced or valgus-impacted fracture

   Screw fixation preserves the native head and neck.

3. Young patient with a displaced fracture

   Urgent anatomic reduction and rigid fixation give the best chance of preserving the head.

4. Inability to tolerate prolonged recumbency

   Surgery allows rapid mobilization, which is especially important in elderly patients.

How it works

For screw fixation, three cannulated screws are placed in parallel through small incisions on the side of the hip under fluoroscopic guidance. A sliding hip screw-and-plate construct is an alternative for certain patterns.

For hemiarthroplasty, a standard hip approach is used to remove the fractured head. A metal stem is placed down the femur and a matching metal head articulates with the patient's native acetabulum. Modern implants are typically cemented in elderly patients for immediate stability.

Recovery

After screw fixation, weight-bearing is usually protected during early recovery. After hemiarthroplasty, most patients are allowed to weight-bear as tolerated on day one and mobilized with physical therapy. Regardless of implant, early mobilization is critical to avoid the medical complications of immobility. The follow-up focus is on detecting late complications such as avascular necrosis or conversion to total hip replacement if symptoms develop.

Contact

For questions about this procedure or to schedule an evaluation, call the office at (830) 625-0009 or request an appointment online.

Weight-Bearing After Repair

Controlled load is part of how bone heals. Once the fracture is stabilized with hardware, gentle weight through the limb stimulates the biology that builds callus and remodels bone — completely offloading a fixed fracture for too long can actually slow healing and stiffen the joint above and below. Full body weight right away, however, can overload the construct before bone has caught up. The right answer sits in between: a partial weight-bearing progression decided by your surgeon based on your fracture pattern, the strength of the fixation, your bone quality, and how the repair looks on post-op imaging. We tell you exactly how much weight the limb can take, when to advance, and what to watch for.

Risks & Why We Still Recommend It

Every operation carries risk. The reason we offer this procedure is that the condition, left untreated, causes a displaced fracture of the femoral neck that cannot heal on its own and leaves the leg unable to bear weight. That is the trade we are managing — not eliminating risk, but choosing the smaller of two unfavorable trajectories.

The risks we discuss with patients before femoral neck fracture fixation (orif or hemiarthroplasty) include:

• bleeding and infection
• anesthesia risk
• blood clot (DVT/PE)
• avascular necrosis of the femoral head, particularly with displaced patterns
• non-union or cut-out of the fixation
• leg-length discrepancy
• need for conversion to hip replacement if fixation fails

The indication to proceed is an acute femoral neck fracture — the decision between fixation and hemiarthroplasty turns on fracture pattern, displacement, and patient age. Patients who don't need this operation don't get it.

Further Reading

External patient-education references and related OSI pages for additional background:

• Britannica — Bone disease (fractures)
• Britannica — Hip (anatomy)
• AAOS OrthoInfo — patient education library
• OSI glossary — orthopedic terminology in plain language