Fracture Neck of Femur and Hemiarthroplasty in Pune: Treatment Explained
A pre-operative X-ray showing a displaced femoral neck fracture.
A fall at home can break the neck of the thigh bone. For many older adults, the injury changes how they stand, walk and sleep in a single moment. The first questions are usually the same: will I need surgery, and what kind?
This guide explains what a femoral neck fracture is, why the type of break matters, and how surgeons choose between fixing the bone and replacing the ball of the hip with a partial hip replacement called hemiarthroplasty. It is written for patients and families in Pune who want clear information before a consultation.
An intra-operative image showing a hemiarthroplasty implant, with the stem, neck and head seated in the hip.
What is a femoral neck fracture?
The femoral neck is the narrow section of the thigh bone between the rounded head, which sits in the hip socket, and the long shaft below. A break in this part of the bone is called a fracture of the neck of femur, or a femoral neck fracture. It is different from a fracture of the trochanter, the bony bump on the outer side of the upper thigh, which is often treated in another way.
Where the break happens
Surgeons describe the position of the break in simple terms:
Subcapital: just below the head of the femur.
Transcervical: through the middle of the neck.
Basicervical: at the base of the neck, close to where it joins the shaft.
The exact position affects how stable the bone is and which treatment is suitable.
Undisplaced and displaced fractures
An undisplaced fracture is a crack where the bone pieces stay in line. A displaced fracture is one where the pieces have moved out of position.
The Garden classification is a scale doctors use to describe how far the break has moved. In plain words:
Stage I: an incomplete break where the broken ends are pushed firmly together.
Stage II: a complete break with no movement between the pieces.
Stage III: a complete break where the head has partly tilted out of line.
Stage IV: a complete break where the head has moved fully out of line with the socket.
The scale helps guide the choice of treatment. It is not the only factor. Your age, bone quality and general health also matter.
Why blood supply matters
The head of the femur receives its blood supply mainly through small arteries that run along the neck. When a fracture is displaced, these vessels can be stretched or torn, and blood flow to the head may be reduced. Reduced blood flow can lead to avascular necrosis, a condition where part of the bone dies.
Displacement also makes it harder for the two pieces of bone to knit together. When a fracture does not heal, this is called non-union. Both risks are the main reasons displaced fractures in older patients are often treated with a replacement rather than with screws alone.
Who gets a femoral neck fracture?
Femoral neck fractures are common in older adults. Most follow a low-energy fall, such as slipping in the bathroom, tripping on a step at home or losing balance while getting up from a chair.
Osteoporosis, a condition where bones become thinner and more fragile, is a major reason a fall that would not normally break a bone can do so. Women are affected more often than men, particularly after menopause, when bone density tends to fall.
Younger adults can also break the femoral neck. This usually happens after high-energy trauma, such as a road accident or a fall from height. These fractures are often more displaced, and they need prompt surgery so the natural hip can be preserved wherever possible.
Common risk factors
Age and osteoporosis
Low vitamin D or calcium intake
Long-term use of steroid medicines
Smoking and heavy alcohol use
Reduced mobility, poor vision or balance problems
Medicines that cause dizziness or drowsiness
Conditions that affect the nerves or muscles
Symptoms of a femoral neck fracture
Common signs include:
Pain in the groin, the front of the hip or sometimes the knee
Inability to stand or put weight on the leg
A leg that looks shorter and turned outward
Bruising or swelling around the hip
Some undisplaced fractures are less obvious. A person may still be able to walk with pain. Groin or hip pain after a fall should always be checked with an X-ray, even when the leg looks normal.
When to go to the emergency department
Get medical help without waiting if you or someone near you:
Cannot stand or walk after a fall
Has a leg that looks shortened or turned outward
Has severe groin or hip pain that does not ease
Has a fall with a head injury, fainting or chest pain
Has numbness, a cold foot or loss of movement in the leg
Keep the leg still and do not try to straighten it. Ask the hospital team whether you can eat or drink before any surgery.
How is a femoral neck fracture diagnosed?
Diagnosis starts with a clinical examination and an X-ray. A pelvic X-ray that includes both hips allows the surgeon to compare the two sides. Where the X-ray is unclear, especially with a small undisplaced crack, a CT scan or MRI scan may be arranged. Blood tests and a heart check are also done when surgery is planned, so the anesthesia team can judge fitness.
Treatment options for a femoral neck fracture
Non-operative care
Treatment without surgery is rare for femoral neck fractures. It may be considered for a patient who is too unwell for an operation. It involves long periods of rest and the risks of lying still, including pressure sores, chest infection and blood clots. The fracture can also move over time, so it is not a common choice.
Cannulated screw fixation
Cannulated screws are hollow screws placed across the fracture to hold the pieces together. This option is usually considered for undisplaced or minimally displaced fractures, most often in younger patients with good bone quality. It keeps the natural hip joint. The fracture must heal, and the blood supply to the head must survive. If either fails, a later replacement may be needed.
Dynamic hip screw
A dynamic hip screw is a sliding screw and side plate. It is mainly used for fractures at the base of the neck and in the bony area just below it, rather than for the narrow neck itself. The screw allows the bone to settle as it heals.
Hemiarthroplasty
Hemiarthroplasty replaces only the ball of the hip. The surgeon removes the broken head and neck and places a metal stem in the thigh bone, with a new head that fits into the natural socket. The natural socket is left in place.
It is often chosen for displaced fractures in older patients who have lower daily activity, weaker bone, or a higher risk that the fracture will not heal or that the head's blood supply has been lost. Hemiarthroplasty does not depend on the fracture healing, and it allows early walking.
Total hip replacement
Total hip replacement replaces both the ball and the socket. It may be considered for older patients who are fit and active, have healthy socket cartilage, and want to keep walking and taking part in everyday activities. It involves a longer operation and a longer recovery, so it is not suitable for everyone.
How surgeons choose the right option
No single factor decides the treatment. A surgeon considers the whole person, including:
Age and general life expectancy
Activity level before the fall, and what the patient wants to get back to
Bone quality, which affects how well screws or a stem will hold
Memory and cognition, which affect safe walking after surgery
Fitness for anesthesia, including the heart, lungs and other medical conditions
Other joint problems, such as arthritis in the hip or knee
Home support during recovery
In general, younger patients are usually offered fixation, so the natural hip can be kept. Older patients with lower daily demands are often offered hemiarthroplasty. Older patients who are fit and active may be considered for total hip replacement. The surgeon explains the options and their advantages and limits, and the final decision is made together with the patient and family.
Choosing the implant for hemiarthroplasty
When hemiarthroplasty is chosen, the surgeon makes a few decisions about the implant. They are explained here in plain words. The fit and the reasoning matter more than any brand name.
Unipolar or bipolar head
A unipolar head is a single metal ball that moves against the natural socket. A bipolar head has a smaller inner ball that moves inside a larger outer shell. Surgeons choose between them based on the patient's age, activity and the condition of the socket cartilage.
Cemented or uncemented stem
A cemented stem is fixed into the thigh bone with bone cement. An uncemented stem has a textured surface that the bone grows into over time. Cemented stems are often used when bone quality is weak. Uncemented stems are often used when the bone is strong enough to hold the implant on its own.
Modular head
A modular head allows the surgeon to choose the size and length of the head to suit the patient's leg and the tension of the soft tissues around the hip.
Bone quality
Bone quality is a key reason for choosing a stem. Good bone supports a secure fit. Weaker bone may need cement to hold the implant firmly in place.
The surgery, early walking and recovery
Surgery is usually done once the patient is medically fit. Waiting too long can increase the risk of complications, so timing is planned with the anesthesia team.
The anesthetist chooses between spinal anesthesia, which numbs the body from the waist down, and general anesthesia, which puts the patient to sleep. The choice depends on the patient's health and the surgeon's plan.
Early mobilisation
Physiotherapists usually help patients sit up and stand soon after surgery, often within a day, using a walking frame or crutches. Early movement lowers the risk of chest infection, blood clots and pressure sores.
Physiotherapy and home recovery
Physiotherapy focuses on walking, balance and strength. Many patients need a walking aid and help at home for several weeks. Recovery is gradual, and the timeline differs from person to person. Your surgeon and physiotherapist will set goals with you.
Precautions
The surgeon will explain which hip movements to avoid during the first weeks. These precautions protect the new joint while the soft tissues heal. Follow them closely, and ask the team if you are unsure.
Risks, stated honestly
Every operation carries risks. For hemiarthroplasty these can include:
Bleeding and infection at the wound
Blood clots in the leg or lungs
Dislocation of the new joint
Injury to nearby nerves or blood vessels
Stiffness or a difference in leg length
Chest infection, heart problems or confusion, which are more likely in older patients
Loosening or wear of the implant over time, which may need a further operation
The team takes steps to reduce these risks, including early walking, blood-thinning medicines where needed, and careful planning with the anesthesia team. Your surgeon will discuss your own risks after examining you.
Dr Sunny Dole's approach to care before surgery
Surgery is planned step by step. Dr Sunny Dole follows a set routine before a hemiarthroplasty and adjusts it for each patient. The steps below describe standard orthopedic practice.
Emergency assessment and pain relief
A patient with a hip fracture is first assessed in the emergency department. The team checks breathing, blood pressure, pulse and any other injuries from the fall. Pain is treated early with medicines given by injection or tablet, and a nerve block may be used in some cases. Good pain control makes it easier to move the patient safely and to complete the scans.
History and examination
The surgeon asks about the fall, existing illnesses, medicines (especially blood thinners, diabetes medicines and steroids), allergies, past operations, and how well the patient was walking and managing at home before the fall. The leg is examined for length, rotation, blood flow, feeling and movement.
X-ray, CT and MRI scans
An X-ray of the pelvis that includes both hips is taken, so the surgeon can compare the two sides. A CT scan or MRI scan is added when the fracture is hard to see on X-ray, or when more detail is needed to plan the operation.
Blood tests, ECG and chest X-ray
Blood tests check the haemoglobin level (to detect anaemia), blood sugar, kidney function, salts in the blood and clotting. An ECG, which records the heart rhythm, and a chest X-ray are also done. Further heart or lung tests are arranged if the patient has a known heart or breathing condition.
Fitness check by physician and anaesthetist
A physician, and a cardiologist where needed, reviews the patient's heart, lungs and other medical conditions. The anaesthetist separately checks fitness for anaesthesia. These reviews aim to lower the risk of surgery. They are kept focused, because a delay can also increase risk.
Correcting anaemia, blood sugar and blood pressure
If the blood count is low, iron or a blood transfusion may be given. Blood sugar is brought under control, and blood pressure is adjusted. Each of these steps lowers the risk of wound infection, poor healing and heart problems during surgery.
Preventing blood clots
Patients who cannot walk well are at higher risk of blood clots in the leg and lungs. The prevention plan usually includes blood-thinning injections or tablets started at the right time, compression stockings, and gentle leg movements. The plan is adjusted for kidney function and bleeding risk.
Antibiotics before surgery
An antibiotic is given shortly before the incision to lower the risk of infection. The choice of antibiotic depends on allergies and the hospital's protocol.
Consent and family counselling
The surgeon explains the options, why one is advised, the risks, what recovery usually involves and what cannot be guaranteed. Family members are welcome to join this discussion, because they often help with care at home. Consent is taken only after questions have been answered.
Fasting instructions
The team gives clear instructions on when to stop eating and drinking before the operation. Follow them exactly, and tell the team about any tablets taken that morning.
Marking the operated limb
The operated side is marked on the skin and checked again by the team before surgery, to confirm the correct side is operated on.
Planning the implant size
Before surgery, the surgeon measures the X-ray images to estimate the size of the head and stem. This planning, called templating, helps prepare the right implant. The final size is confirmed during the operation.
Choosing the implant type
Based on the bone quality seen on X-ray and during surgery, the surgeon decides between a cemented and an uncemented stem. The head type, unipolar or bipolar, is chosen according to the patient's age, activity and the health of the natural socket.
What happens during the operation
The steps below describe a typical hemiarthroplasty. The exact approach is chosen for each patient.
Anaesthesia
Many hip operations are done under spinal anaesthesia, which numbs the body from the waist down, so the patient stays awake without feeling pain. It is often combined with a nerve block for pain relief after surgery. General anaesthesia, where the patient is asleep, is used when spinal anaesthesia is not suitable. The anaesthetist monitors heart rate, oxygen and blood pressure throughout.
Positioning and sterile preparation
The patient lies on a special operating table, on the side or on the back, depending on the approach. The position is padded carefully to protect the skin and nerves. The skin around the hip is cleaned with an antiseptic solution and covered with sterile drapes, and the team wears sterile gowns and gloves to lower the risk of infection.
Antibiotics and the incision
The antibiotic is given before the incision, and repeated during long operations. The surgeon makes an incision over the hip and moves the muscles aside carefully to reach the joint. The approach is chosen to protect the blood supply and the muscles that support the hip.
Removing the fractured head
The broken femoral head and neck are removed. The surgeon also checks the natural socket for damage to its cartilage, and decides whether it can be left as it is.
Sizing the socket and head
The surgeon measures the socket and selects a head of the right size. The head must fit well, so the hip moves smoothly without unnecessary strain.
Preparing the thigh bone and inserting the stem
The inside of the thigh bone is shaped with special instruments, so that it can take the stem. If cement is used, it is mixed and placed in the canal before the stem goes in. The surgeon controls the position of the stem carefully as it is inserted.
Trial reduction and stability checks
Before the final head is fixed, a trial head is placed to check the fit. The surgeon moves the leg through its range of movement, checks that the hip is stable, and compares leg length and rotation with the other side. Adjustments are made as needed.
Checking the position with the image intensifier
An image intensifier, a portable X-ray machine called a C-arm, is used during surgery to confirm the position of the stem and head. The intra-operative image shown at the start of this article is an example of this check. It helps confirm the implant is seated correctly before the wound is closed.
Closure and dressing
The muscles and tissues are repaired in layers. A drain may be placed to remove fluid, and the skin is closed with stitches or staples. A sterile dressing is applied, and the team checks blood flow and movement in the foot before the patient leaves the operating room.
Care after the operation
Recovery room and ward monitoring
After surgery, the patient is watched closely in the recovery room until awake and stable. On the ward, the team checks blood pressure, pulse, oxygen levels, urine output and the dressing. They also watch for early signs of complications.
Pain control
Pain relief is given on a regular schedule, rather than waiting for the pain to become severe. Good pain control helps the patient breathe deeply, sit up and take part in physiotherapy.
Antibiotics and blood-thinning medicines
A short course of antibiotics may be continued after surgery, as the team decides. Blood-thinning medicines continue for a set period to prevent clots. Compression stockings and calf exercises are used alongside them. Keep taking every medicine exactly as prescribed.
Wound care
The dressing is checked regularly. Keep the wound clean and dry, and avoid creams or powders unless the team advises them. Report any redness, swelling or discharge. Stitches or staples are removed once the wound has healed, usually at a follow-up visit.
Sitting and standing early
Patients are usually helped to sit on the edge of the bed on the same day or the next day. With a walker and a physiotherapist, they stand and take first steps as soon as it is safe. Early movement lowers the risk of chest infection, clots and pressure sores.
Chest physiotherapy
Deep breathing, coughing exercises and, where advised, a breathing device help keep the lungs clear after anaesthesia and during bed rest.
Nutrition, protein, calcium and vitamin D
Protein helps the body heal. Good sources include eggs, milk, dal, paneer, chicken, fish and soya. Calcium and vitamin D support bone healing, and the team checks their levels. A dietitian can help if appetite is poor.
Osteoporosis treatment
A fracture from a low-energy fall is often a sign of weak bones. The team may start treatment for osteoporosis to lower the risk of another fracture. The plan is decided after blood tests and a bone density test, called a DEXA scan.
Follow-up X-rays and visits
An X-ray is taken after surgery to check the position of the implant. A follow-up visit is booked before discharge. At these visits the wound, walking, pain, medicines and X-rays are reviewed, and stitches or staples are removed if they have not already been taken out.
How long is the hospital stay?
Hip fracture surgery requires a hospital admission. The stay is typically several days, and the exact length varies. It depends on fitness before surgery, how the wound heals, and how well the patient can walk with support.
Discharge happens only when:
The patient can walk safely with support
Pain is controlled with tablets
The wound is clean and dry
Family members have been trained in walking, exercises and home safety
Your surgeon will give you an updated estimate as your recovery progresses.
Instructions after hemiarthroplasty
The guidance below is the standard advice patients receive after hip replacement or hemiarthroplasty. Dr Sunny Dole individualises these instructions to the surgical approach and to each patient's recovery. Follow the written advice given at discharge, and ask the team if anything is unclear.
Movement and daily activities
Use a walker or crutches every time you walk until your physiotherapist says otherwise.
Follow the hip precautions given for your surgical approach, such as not crossing your legs or turning the operated leg inward.
If advised, do not bend the hip beyond 90 degrees. Use a long-handled reacher to pick up objects from the floor.
Avoid low chairs, low toilets and soft sofas. Use a raised toilet seat and a firm chair with armrests.
Avoid squatting and sitting cross-legged on the floor, as your surgeon advises, until it is confirmed safe.
Do not twist or pivot on the operated leg.
Sleep on your back, or on the side of the non-operated leg. Place a pillow between your knees if advised.
Do not drive until your surgeon confirms it is safe.
Making the home safe
Remove loose rugs and cables from walkways.
Fit grab rails in the bathroom and use night lights in corridors.
Keep everyday items at waist height.
Have someone nearby during the first weeks at home.
Wound, medicines and general care
Keep the wound clean and dry. Follow the bathing advice given at discharge.
Take medicines on time, including blood thinners and antibiotics, exactly as prescribed. Do not stop them without asking the team.
Tell every doctor and dentist that you have a hip implant.
If your surgeon advises antibiotic cover before dental or other procedures, take it as prescribed.
Exercises and nutrition
Do your physiotherapy exercises every day, as you were taught.
Move your ankles and toes often to help prevent clots.
Include protein at each meal, drink enough fluids, and eat foods rich in calcium and vitamin D.
Bone health and follow-up
Take any osteoporosis treatment as prescribed.
Keep every follow-up appointment and X-ray.
Warning signs
Contact the team, or go to the emergency department without delay, if you notice:
Fever or chills
Discharge, bleeding or spreading redness from the wound
Swelling, pain or warmth in the calf, which may be a clot
Chest pain, breathlessness or coughing up blood
Sudden, severe pain in the hip or thigh
Inability to bear weight on the leg
A leg that looks shorter or turned outward, or sudden pain with the leg turning inward
Confusion or unusual drowsiness
Dr Sunny Dole's experience in hip reconstruction
Dr Sunny Dole is an orthopedic trauma and joint replacement surgeon in Pune. Hip fracture surgery and total hip replacement are among his services, alongside fracture care, lower and upper limb trauma surgery, robotic-assisted joint replacement and arthroscopy.
Dr Sunny Dole has performed thousands of hip surgeries, including hip fracture surgery and hip replacement.
His training includes an MBBS from Dr. Vaishampayan Government Medical College, Solapur, a Diploma in Orthopedics from Maharani Laxmibai Government Medical College, Jhansi, and a DNB in Orthopedic Surgery from Kokilaben Dhirubhai Ambani Hospital, Mumbai.
Every hip fracture is assessed individually, and the treatment is planned around the patient's age, health and goals.
Where to meet Dr Sunny Dole in Pune
Kothrud Orthopedic Clinic. Office 401, Success Square CHS, Karve Road, Kothrud, Pune 38. Consultations and follow-up visits are held here. Call 92721 06008 or book through www.sunnydole.com.
Hospitals across Pune. Dr Sunny Dole sees and operates on patients at:
Golden Care Hospital, Hinjewadi
Aditya Birla Memorial Hospital, Pimpri-Chinchwad (on call)
Lokmanya Hospital, SB Road
ONP Hospital, Shivajinagar
Sanjeevan Hospital, Erandwane (Mondays, 10:00 AM to 12:00 PM)
Deoyani Multispeciality Hospital (on call)
Patients come from Kothrud, Erandwane, Sadashiv Peth, Bavdhan, Hinjewadi, Wakad, Narhe, Ravet and Pimpri-Chinchwad. The right location depends on your injury, your home and your insurance. The team will guide you.
For more on hip fracture care and total hip replacement, visit www.sunnydole.com.
Insurance and cashless support
Many hip fracture patients need help with mediclaim paperwork at a stressful time. The team supports cashless pre-authorization and reimbursement paperwork. Acceptance differs by insurer, policy and hospital, so please confirm with your insurer and the hospital desk before admission.
Frequently asked questions about femoral neck fracture surgery
Does every femoral neck fracture need surgery?
Surgery is the usual treatment for femoral neck fractures. Non-operative care is rare, and it is considered only for patients who are too unwell for an operation.
Can a femoral neck fracture heal without an operation?
Some very minor, stable fractures may be managed without surgery under close supervision. Surgery is usually advised so the bone can be held in place and the patient can start walking sooner.
What is the difference between hemiarthroplasty and total hip replacement?
Hemiarthroplasty replaces only the ball of the hip and leaves the natural socket. Total hip replacement replaces both the ball and the socket. Total hip replacement is usually considered for fit, active patients with healthy socket cartilage.
Will I be able to walk after a hemiarthroplasty?
Many patients stand and walk with support soon after surgery, with physiotherapy guiding each step. Walking independently takes longer, and the timeline varies between patients.
Why is hemiarthroplasty chosen instead of screws for some older patients?
Screws depend on the fracture healing and on the head keeping its blood supply. In a displaced fracture in an older patient, these may be less certain. A replacement does not rely on healing, so the patient can usually move sooner.
What is avascular necrosis of the femoral head?
Avascular necrosis means that part of the femoral head loses its blood supply and begins to die. It can develop after a displaced fracture. Treatment depends on how the hip develops, and it may include replacing the head.
How soon should a hip fracture be operated on?
Surgeons generally aim to operate as soon as the patient is medically fit. An early assessment helps the team plan the safest timing.
Does a hemiarthroplasty last forever?
No joint replacement lasts forever. Implants can loosen or wear over time, and some patients need a further operation. Your surgeon will explain this in your own case.
How long will I stay in hospital after hip fracture surgery?
Hospital admission is required for this surgery. The stay is typically several days, and the exact length varies with fitness, wound healing and how well you can walk with support. You can go home once you are walking safely with help, pain is controlled, the wound is clean and your family has been trained.
When can I walk after a hemiarthroplasty?
Patients are usually helped to stand and take first steps soon after surgery, often on the same day or the next day, with a walker and a physiotherapist. Walking distance increases gradually. Walking without support takes longer, and the timeline differs for each patient.
When can I climb stairs or squat?
Stairs and squatting are introduced slowly, under physiotherapy guidance. Squatting, and sitting cross-legged on the floor, are avoided until your surgeon says they are safe. Stairs are usually practised with a rail and someone nearby before using them alone. Your surgeon will tell you when.
When can I drive?
Driving is restarted only when your surgeon confirms that you have enough control of the leg to brake safely and can get in and out of the car comfortably. Do not drive while taking medicines that cause drowsiness.
Can I use my health insurance for hip fracture surgery?
Cashless and reimbursement support is available. Confirm your policy and the hospital's acceptance before admission.
How do I book a consultation?
Call 92721 06008 or use the appointment booking on www.sunnydole.com.
This article is for general education. It is not medical advice and does not replace an examination by a qualified doctor. If you have a hip injury or a fall, please see an orthopedic doctor or go to an emergency department.
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