Abstract
To properly care for femoral neck fractures, the surgeon must decide which fractures are to be fixed and which fractures will require a prosthesis. In addition, the type of prosthesis, hemiarthroplasty versus total hip arthroplasty must be selected. Total hip arthroplasty is an option in the active elderly.
The literature supports internal fixation in non-displaced fractures. Current literature supports the fact that ORIF of displaced femoral neck fractures results in failure and re-operation of 20% to 30%. By considering arthroplasty when the patient has multiple co-morbidities including renal disease, diabetes, rheumatoid arthritis and severe osteoporosis the re-operation rate can be reduced significantly. The single most important factor in preventing failure with fixation is an anatomic reduction. A femoral neck fracture left in varus is doomed to failure and re-operation.
A prosthesis should be used in most displaced femoral neck fractures in patients physiologically older than 65. In active elderly patients total hip replacement should be considered. In elderly patients with multiple co-morbidities who are relatively inactive in a nursing home or lower level community ambulators, a hemi-prosthesis should be considered. The decision-making process is always shared with the patient.
When a prosthetic replacement is performed, the low level nursing home or community ambulator who is not expected to live longer than six to seven years is a candidate for a cemented hemi-arthroplasty. Studies report a 25% – 30% re-operation rate in hemi-arthroplasty if the patient survives greater than six to seven years. In the active elderly with little co-morbidity, a total hip replacement should be used. This is not only cost effective but provides the best pain relief of any of the options for treatment of displaced femoral neck fractures. Treatment of femoral neck fractures remains a challenge but the surgeon must select the proper treatment based on fracture displacement, physiologic age of the patient as well as co-morbidities of the patient.
