Symptoms of a femoral neck fracture.
A femoral neck fracture is one of the most common and serious injuries of the musculoskeletal system, especially in elderly people. Surgeons, traumatologists, and many other doctors, such as gerontologists, encounter the diagnosis of this injury. In almost 95% of cases, a correct diagnosis can be made without using an X-ray machine. Sometimes, I arrive at a call as a gerontologist and need to figure out what to do next with this patient who was still walking yesterday but is lying down today.
What are the symptoms and signs of a femoral neck fracture?
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One of the typical manifestations of a femoral neck fracture is the so-called «stuck heel» sign. This sign involves the patient experiencing significant difficulty when trying to lift the heel of the injured leg off the bed. This is due to a violation of the integrity of the bone structure of the hip. So, we ask the patient to lift their straightened leg… and nothing happens.
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The second clinical sign is the shortening of the limb on the side of the fracture. This occurs due to the displacement of bone fragments and the loss of the anatomical length of the femur. This shortening is often noticeable even visually and can range from 0.5 to 1–2 centimeters. To check this sign, you need to position the patient geometrically straight and look at their heels. The injured limb will be 1–2 centimeters shorter.
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The next important symptom is the external rotation of the foot, which can be observed on the foot. Simply put, the toes of the healthy leg point (are directed) upwards, towards the ceiling. The toes of the injured leg point not upwards, but slightly to the side. This is a very simple and telling sign.
An important additional sign. The very fact of the injury itself. If the patient has fallen, we should immediately suspect this pathology. Well, if they definitively deny falling, then we need to think further and analyze.
If you have identified at least two out of three signs, it is a femoral neck fracture. Of course, an X-ray is still needed to clarify the nature of the fracture and choose the method of treatment. Sometimes a traumatologist will recommend surgery, sometimes they will say that surgery is not needed here.
