Femoral neck fractures

Abstract

As the elderly population grows, femoral neck fractures are assuming increasing socioeconomic importance. Proper treatment of these injuries is critical for the health of the population and the health of the economy. The displaced fracture of the femoral neck with compromised blood supply to the femoral head remains in many ways today the "unsolved fracture" as far as treatment and results are concerned (Canale, 1998). Accurate fracture reduction in facilitating implant placement as well as good surgical technique are critical for successful outcomes. Significant controversy remains regarding the use of primary total hip arthroplasty for displaced femoral neck fractures in a population traditionally treated with internal fixation or monopolar devices. To date, however, there is a paucity of prospective, randomized comparative studies demonstrating this to be a significantly better treatment. In the younger patient with a femoral neck fracture secondary to high-energy injury, however, it is widely agreed that preservation of the femoral head should be the goal of treatment. Generalizations about treatment in the elderly population are difficult given the confounding factors and comorbidities that contribute to their postoperative outcome. Furthermore, poor follow up has made most of the clinical review studies incomplete. With the growth of our aging population, more long-term comprehensive studies should be forthcoming to aid the orthopaedic surgeon in choosing the appropriate treatment modality.