The femoral neck connects the femoral head to the shaft at the neck-shaft angle (normally 120 to 135 degrees in adults) and the anteversion angle (normally 10 to 15 degrees of forward torsion). The trabecular architecture within the neck follows the lines of compressive and tensile stress (Ward triangle, calcar femorale), providing maximum strength with minimum material. The retinacular vessels supplying the femoral head run along the femoral neck surface, making them vulnerable to disruption by neck fractures.
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| Ossification | The femoral neck has no separate ossification centre, it ossifies from the primary diaphyseal centre alongside the femoral shaft, with the neck-shaft angle decreasing from approximately 150 degrees at birth to the adult 125 to 135 degrees as the child begins weight bearing. |
Garden classification of femoral neck fractures grades displacement (I: impacted valgus, II: undisplaced, III: partial displacement, IV: complete displacement). Garden III and IV fractures have the highest risk of avascular necrosis (30 percent) and non-union. In patients under 65 years, anatomical reduction and internal fixation is preferred to preserve the femoral head; in older patients, arthroplasty (hemi- or total hip replacement) avoids the non-union and AVN risks. Neck-shaft angle variations (coxa valga more than 140 degrees, coxa vara less than 120 degrees) affect hip abductor mechanics.
Common in older adults after falls; displaced intracapsular fractures can disrupt the blood supply to the femoral head and often need joint replacement.
Seen in runners and recruits; tension-side (superolateral) fractures risk displacement and usually need fixation.
Extra bone at the head-neck junction abuts the acetabular rim in flexion and rotation, damaging the labrum and cartilage.
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