Overview
A femoral neck fracture is a break in the upper part of the thigh bone (femur) just below the ball of the hip joint. The femoral neck is an area with limited blood supply, which is why this injury can be associated with pain and problems with healing. When the fracture is displaced or unstable, it may also threaten the blood flow to the femoral head, increasing the risk of long-term complications. Most cases occur after a fall, especially in older adults, and they are treated and monitored carefully to protect the hip.
Symptoms
Patients typically feel pain in the groin or outer hip after a fall or twisting injury. Standing or walking may become very difficult, and you may notice trouble bearing weight or a limp. In some cases, the leg may look shorter or rotate outward, and pain can worsen with hip movement such as putting on socks, getting in a car, or trying to turn in bed. Bruising and swelling can occur, though deep hip fractures may not show much visible change early.
Causes
Femoral neck fractures usually happen from a fall onto the side of the hip or a direct impact, particularly in people with weaker bones. In younger people, they more often result from higher-energy trauma such as a car crash or sports injury. If the fracture occurs in an area with compromised blood flow, the injury can become more painful and healing may be slower or less reliable.
Risk Factors
Risk increases with age because falls are more common and bone strength often decreases due to osteoporosis or osteopenia. Certain medical conditions such as vitamin D deficiency, Parkinson's disease, neuropathy, or long-term steroid use can raise the likelihood of both falls and fractures. Lifestyle factors such as smoking and low physical activity may contribute to weaker bones. Having a prior fracture or a history of osteoporosis strongly increases risk.
Prevention
You can lower risk by reducing falls through home safety changes such as removing loose rugs, improving lighting, and using grab bars where needed. Strength and balance training, vision correction, and reviewing medications that cause dizziness can help prevent falls. Supporting bone health with adequate calcium and vitamin D, staying physically active, and using osteoporosis treatment when prescribed can reduce fracture risk. Avoiding smoking and limiting heavy alcohol intake can also improve bone health.
How the Diagnosis Is Evaluated
Clinicians start with your injury history, symptoms, and ability to bear weight, followed by a careful hip exam to assess pain, range of motion, and leg position. They look for typical signs such as groin pain, inability to walk, or possible leg shortening and outward rotation in displaced fractures. X-rays are usually the first test, and if the fracture is not clearly visible but suspicion remains high, CT or MRI may be used to detect an occult femoral neck fracture. Repeat imaging may be considered in some cases when early X-rays are inconclusive.
Nonsurgical Treatment Options
Conservative (nonoperative) care may be considered in selected situations, such as certain nondisplaced fractures or when surgery is not appropriate due to medical reasons. Treatment focuses on controlling pain and protecting the hip with limited or protected weight-bearing using a walker or crutches. Clinicians typically provide a structured mobility plan, which may include short-term bed rest for comfort and a gradual return to movement as guided by follow-up imaging and exam. Physical therapy is often used to maintain safe strength and mobility while reducing the risk of further falls. You may also receive medication for complications associated with immobility, such as blood clot prevention, based on your risk and clinician preference.
When to Seek Medical Attention
Seek urgent medical evaluation if you have severe hip or groin pain after a fall, cannot bear weight, or develop worsening pain with attempts to move the leg. Prompt care is especially important because some femoral neck fractures may be missed on the first evaluation and because timely decisions affect outcomes. Go to the emergency department if you cannot stand, if the leg appears shortened or rotated, or if you have fever, rapidly increasing swelling, or signs of infection. Call for urgent help if you have new numbness or weakness in the leg or foot.
Frequently Asked Questions
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Recovery often takes several months and depends on whether the fracture is stable, how well it heals, and your starting level of mobility and bone health.
Next Steps
If you suspect a femoral neck fracture, avoid weight-bearing and arrange urgent medical evaluation for imaging and an orthopedic plan. Ask whether your fracture is nondisplaced versus displaced and what follow-up imaging and weight-bearing restrictions apply to your specific case. Follow the mobility and physical therapy guidance closely to support safe recovery and reduce the risk of falls.