Delayed diagnosis of femoral neck fracture: A case report and literature review

Abstract

Introduction

Femoral neck fractures are common in elderly resulting from minor trauma. In resource limited settings, these fractures are sometimes missed in radiographic interpretation which delays the treatment and risk of morbidity and mortality increases.

Case presentation

We report the case of a 72-year-old male who presented to a primary healthcare facility with complaints of pain in the left hip and lower back following a fall. He was misdiagnosed with a soft tissue injury and managed conservatively with pelvic traction. Due to persistent symptoms and inability to bear weight, he sought a second opinion six days later. Repeat radiography at our center revealed a displaced femoral neck fracture (Garden Type IV). Considering the patient's age, delayed presentation, and poor socioeconomic condition, uncemented hemiarthroplasty using an Austin Moore prosthesis was performed via the Hardinge (direct lateral) approach. Postoperative recovery was uneventful, and the patient was mobilized early with a walker and discharged on postoperative day seven.

Clinical discussion

Femoral neck fractures, especially non-displaced or minimally displaced types, can be easily missed in elderly patients without a high index of clinical suspicion. Early and accurate diagnosis is essential to prevent complications like avascular necrosis and nonunion. Socioeconomic limitations can delay advanced imaging and definitive care.

Conclusion

This case highlights the importance of thorough clinical evaluation, repeat imaging in persistent cases, and early referral to specialized centers. Delayed diagnosis of femoral neck fracture in the elderly can result in displacement and poorer outcomes if not appropriately managed.