Hip & Pelvis

A hip neck broken in her 50s: fixing it with an FNS instead of a joint replacement

Hee Seung Nam, MD, Orthopedic Surgeon · November 3, 2026

A 52-year-old woman came in with left hip pain after a fall. Tests showed a femoral neck fracture: a break in the neck just below the head of the thigh bone (femur).

In the last column I wrote about a periprosthetic fracture in a patient around 90. Even for the same hip, a patient in her 50s calls for a completely different calculation. This is the story of fixing the fracture to save the patient's own bone instead of replacing the joint, and of choosing a device called the FNS.

Why femoral neck fractures are tricky

The femoral neck is the short neck that joins the round femoral head to the shaft of the thigh bone. The blood vessels to the head run up along this neck, so when the neck breaks, the blood supply to the head can be cut off.

• Avascular necrosis: a head that loses its blood supply can slowly collapse.
• Nonunion: the neck takes large body-weight and twisting forces, so it may fail to heal.

In a meta-analysis of 1,558 femoral neck fractures in young patients, avascular necrosis occurred in 14.3%, nonunion in 9.3% and reoperation in 18.0% after surgery. These complications were more common in displaced fractures. That is why accurate reduction and solid fixation matter above all.

How far has it shifted? The Garden classification

Femoral neck fractures are usually graded by the Garden classification, which asks whether the fracture is complete and how far the head has shifted.

Stage I

Incomplete fracture

Head tilted outward and impacted

Stage II

Complete fracture

Not displaced

Stage III

Complete fracture

Partly displaced; head rotated

Stage IV

Complete fracture

Fully displaced and separated

The CT showed a fracture line just below the left femoral head, with the head shifted out of place. It can be read as roughly a Garden stage III fracture.

Why a joint replacement is not the first choice in your 50s

Displaced femoral neck fractures in older patients are often treated with joint replacement. In the early 50s, though, it is a different story. Replacements wear out, so a young patient is more likely to need at least one revision in their lifetime. For young patients the rule is to reduce the fracture precisely and fix it to save their own femoral head, and not to delay surgery.

Two options: three screws or an FNS

What does recent research say?

An interesting study appeared in 2025 in the Journal of Bone and Joint Surgery (JBJS). Using the hip fracture registry of Kaiser Permanente in the United States, it analyzed 2,038 patients aged 60 and over, comparing the FNS (352 patients) with three-screw fixation (1,686 patients).

• The rate of reoperation within 2 years was 4.0% for the FNS and 4.8% for screws.
• The hazard ratio adjusted for several factors was 0.92 (95% confidence interval 0.50–1.71): no statistically significant difference.
• The result was the same when the comparison was limited to the 72 surgeons who had used both devices.

There are caveats. The study included patients aged 60 and over, and this patient was 52. Studies comparing the FNS with screws in young patients alone are mostly small and retrospective. A meta-analysis of them found slightly higher function scores with the FNS and similar neck shortening.

My choice: the FNS

I used an FNS for this patient. Both methods were evidence-based options, and the difference in reoperation rates in the study was not statistically significant. Still, the number was slightly lower for the FNS (4.0% vs 4.8%). For a young patient whose displaced fracture had to be held firmly in one go, I chose the option that looked even slightly more favorable.

The operation

After reducing the fracture, we fixed it while checking the position in front and side views on intraoperative fluoroscopy.

Postoperative X-rays

Care after surgery

• Weight bearing: increased gradually with crutches or a walker, depending on the fracture pattern and fixation. Displaced fractures in young patients often start cautiously.
• Regular X-rays: avascular necrosis and nonunion can appear 1–2 years after surgery. Even after the bone heals, check-ups continue on schedule in clinic.
• Symptoms to report right away: if pain in the groin or deep in the buttock returns or worsens, see a doctor without waiting for the next appointment.
• Bone health: for a woman in her 50s, a fracture from a fall is a good reason to have a bone density test (osteopenia column).

In closing

• A femoral neck fracture can cut off blood flow to the femoral head, bringing a risk of avascular necrosis and nonunion.
• For young patients such as those in their 50s, the rule is to save their own femoral head with precise reduction and solid fixation rather than a joint replacement.
• In the 2,038-patient study, the FNS and three screws had statistically similar reoperation rates. Accurate reduction and fixation matter more than the device.
• For 1–2 years after surgery, regular X-rays are taken to check progress.

This article is general medical information. Treatment can differ with age, fracture pattern and bone condition, so please confirm through a medical consultation.