Femoral neck fracture is a break across the narrow part of the thigh bone just below the ball of the hip joint. It is a serious form of fracture and a common cause of sudden hip pain, especially after a fall in older adults or major trauma in younger people.

Because this injury can affect blood supply to the femoral head, it usually needs urgent medical assessment and often surgical management. After hospital treatment, physiotherapy helps restore walking, strength, balance, transfers, and confidence so you can safely return to daily activity.

What Is a Femoral Neck Fracture?

A femoral neck fracture is an intracapsular hip fracture that occurs between the femoral head and the main shaft of the femur. This location matters because the blood supply to the femoral head travels across the neck, so displaced fractures carry a higher risk of healing problems, non-union, or avascular necrosis.

Common signs of a femoral neck fracture

• Sudden hip or groin pain after a fall or trauma
• Difficulty standing or walking
• Pain with weight-bearing or hip movement
• A shortened or externally turned leg in more severe cases
• Loss of confidence with transfers, stairs, or balance afterwards

What causes a femoral neck fracture?

In older adults, a femoral neck fracture most often follows a low-impact fall onto the hip, particularly when low bone density or osteoporosis/ is present. In younger adults, it is more often linked to high-energy trauma such as a road accident, a major sporting collision, or a substantial fall.

Risk rises with reduced bone density, poor balance, lower-limb weakness, slower reaction time, some medications, previous falls, and reduced walking confidence. Frailty, deconditioning, and poor nutrition can also make recovery slower once the fracture has occurred.

Common symptoms of femoral neck fracture

A femoral neck fracture usually causes deep hip or groin pain and a sudden drop in walking ability. Some people cannot stand at all, while others with a less displaced fracture may still shuffle a few steps but feel marked pain, weakness, or instability.

Symptoms may include pain during rolling in bed, getting out of a chair, putting weight through the leg, or trying to lift the leg. If you are unsure whether the problem is a fracture or another cause of hip pain, this guide on hip and groin pain causes may also help.

How is a femoral neck fracture diagnosed?

A femoral neck fracture is diagnosed using a combination of history, clinical examination, and imaging. Standard X-rays are usually the first step. If symptoms strongly suggest a hip fracture but the X-ray is unclear, further imaging such as MRI or CT may be needed to confirm the diagnosis.

Why is a femoral neck fracture taken so seriously?

This fracture sits inside the hip joint capsule, close to the blood supply of the femoral head. Because of that, displaced injuries can lead to delayed healing, non-union, or avascular necrosis. It can also significantly affect walking ability, independence, and falls risk, particularly in older adults.

For broader recovery principles after a broken bone, see post-fracture physiotherapy.

How is femoral neck fracture treated?

Femoral neck fracture treatment depends on fracture pattern, displacement, age, bone quality, and pre-injury function. Many displaced fractures in older adults are treated with hemiarthroplasty or total hip replacement, while some undisplaced fractures or younger patients may be treated with internal fixation.

If joint replacement is part of treatment, see hip replacement rehabilitation.

How can physiotherapy help a femoral neck fracture?

Physiotherapy focuses on safe mobility, strength, balance, gait quality, and return to daily function. Early rehab includes walking aids, transfers, and basic strength. Later stages build confidence, endurance, and falls resilience.

We also provide post-operative physiotherapy and musculoskeletal physiotherapy.

Is this injury serious?

A femoral neck fracture is a serious injury, particularly in older adults. Early medical assessment, appropriate surgical care where needed, and guided rehabilitation can make a major difference to mobility, confidence, and recovery.

If you are recovering after surgery or still feel unsteady, weak, or unsure with walking, physiotherapy can help guide your return to safer movement and daily activity.

Prevention and future risk

Reducing future falls is essential. This includes strength, balance, home safety, walking-aid review, and bone health management.

See fall prevention and balance training.

When should you seek urgent medical help?

Seek urgent care if you cannot weight-bear, have severe hip pain after a fall, or your leg looks shortened or rotated. These signs can suggest a hip fracture and should be assessed promptly.

Frequently asked questions

Can you still walk with a femoral neck fracture?

Sometimes, but it is usually painful and unsafe. Some less displaced fractures still allow limited walking, which is one reason they can be missed early. If walking suddenly becomes painful or difficult after a fall, urgent medical assessment is important.

Is this the same as a hip fracture?

Yes. A femoral neck fracture is one type of hip fracture. It occurs just below the ball of the hip joint, inside the joint capsule. Other hip fractures occur in nearby parts of the upper femur and may be treated differently.

Do all cases need surgery?

Not all, but many do. Treatment depends on whether the fracture is displaced, how stable it is, your age, bone quality, and general health. Surgery is often recommended because it usually allows earlier mobilisation and may reduce complications linked to immobility.

How long is recovery?

Recovery can take several months. Early goals include pain control, transfers, and safe walking. Longer-term recovery depends on the fracture type, treatment method, pre-injury fitness, bone health, and whether complications occur during healing.

What is the difference between a femoral neck stress fracture and an acute fracture?

A stress fracture usually develops gradually from repeated loading, often in runners or other active people. An acute femoral neck fracture happens suddenly, most commonly after a fall or major trauma. The symptoms, urgency, and treatment pathway can differ significantly.

What to do next

If you have sudden hip or groin pain after a fall and cannot walk normally, seek urgent hospital assessment immediately. A suspected femoral neck fracture is not a wait-and-see injury.

Once your fracture has been medically managed, physiotherapy can help you regain mobility, rebuild strength, and return to everyday activities more safely and confidently.

References

1. National Institute for Health and Care Excellence. Hip fracture: management. NICE Clinical Guideline CG124. Updated 2023.
2. American Academy of Orthopaedic Surgeons. The Management of Hip Fractures in Older Adults. Plain Language Summary. 2024.
3. Avola M, Inguaggiato E, Mulè M, et al. Rehabilitation Strategies for Patients with Femoral Neck Fractures in Sarcopenia: A Narrative Review. Medicina (Kaunas). 2020;56(10):544. doi:10.3390/medicina56100544
4. Kazley J, Bagchi K. Femoral Neck Fractures. StatPearls Publishing. Updated 2023.