![]() This is merely based on personal believes determining the management of patients than evidence from the literature. While in younger patients (20-50 years), closed reduction and internal fixation (CRIF) is routinely performed, the treatment of older patients with intracapsular femoral neck fractures largely depends on local conditions, patient profiles, personal preferences and training of the surgeon. Therefore, the appropriate treatment of femoral neck fractures is mandatory. Especially in the elderly, femoral neck fractures represent a significant health care problem and have enormous impact on health insurance costs. Paralleling trends of demographic forecasts, their incidence will continue to rise in the future. HA should only be implanted in patients with limited life expectancy.įemoral neck fractures are frequent injuries in the patient population of every trauma center and have a high incidence in the general population. THA is the treatment of choice for femoral neck fractures in patients older than 60 years. Therefore, it can only be recommended as a second line of defense-procedure for patients with low functional demands and limited live expectancy. Based on our findings, bipolar hemiarthroplasty, similar to unipolar hemiarthroplasty, cannot restorate neither anatomical nor biomechanical features of the hip joint. THA is beneficially implanted using an anterior approach exploiting the internervous plane between the tensor fasciae latae and the sartorius muscles allowing for immediate full weight-bearing. THA yields the best functional results in patients with displaced femoral neck fractures with complication rates comparable to HA. The resulting articles were then reviewed with regard to the different techniques, outcome and complications of the distinct reconstruction options. In addition, cross-referencing was used to cover articles eventually undetected by the respective search strategies. The Pubmed database was searched for all articles on femoral neck fracture and for the reconstruction options presented in this review using the search terms "femoral neck fracture", "unipolar hemiarthroplasty", "bipolar hemiarthroplasty", and "total hip arthroplasty". The purpose of this review is to discuss the indications, limitations, and pitfalls of each of these techniques. Reconstruction options using hip arthroplasty include unipolar or bipolar hemiarthroplasty (HA), and total hip arthroplasty (THA). 1994 2(3):141-149.Femoral neck fractures in the elderly are frequent, represent a great health care problem, and have a significant impact on health insurance costs. Overview and evaluation and treatment of femoral-neck fractures. 1,2ĭagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA). Patients should be taken to surgery as soon as they are medically stable to benefit from early mobilization. Prompt recognition and treatment of these fractures is known to improve patient outcomes. The resulting poor blood supply to the femoral neck causes a high incidence of nonunion and osteonecrosis, and therefore, the femoral head will not heal and must be replaced with a prosthesis. Displaced fractures disrupt the hip capsule and blood supply to the femoral neck. Unstable displaced fractures (Garden types 3 and 4) are generally treated with arthroplasty. Stable nondisplaced or valgus-impacted fractures (Garden types 1 and 2) are generally treated with cannulated screw fixation. The classification system has 4 types: type 1 includes incomplete fractures (fracture line partially through the femoral neck) or valgus-impacted fractures type 2 includes nondisplaced fractures type 3 includes complete fractures (fracture line crosses the entire femoral neck) with partial displacement and type 4 includes completely displaced fractures.įor treatment purposes, the classification system can be simplified into 2 categories. The Garden classification system is commonly used to describe and determine treatment of femoral neck fractures. ![]() The expected increase in osteoporotic-related fractures is particularly concerning, as hip fractures alone carry up to a 25% mortality rate within the first year. Among the elderly, low-energy falls that result in a fracture are most often the result of osteoporosis or poor bone quality. As the population ages, hip fractures are becoming an increasingly common presentation in emergency rooms.
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