title: Fractured neck of femur--internal fixation versus arthroplasty.
abstract: BACKGROUND
  Surgery is the treatment of choice for fractured neck of femur. For middle-aged patients (aged ca. 40 to 65), there is considerable debate over the indications for arthroplasty or internal fixation. The choice of surgical technique varies widely from one region to another. In this article, we discuss the main criteria that should be used in making this decision.
  
  
  METHODS
  We selectively reviewed the literature on the diagnosis and treatment of fractured neck of femur, including the current guideline of the German Society for Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie, DGU) and recent findings from the field of health services research.
  
  
  RESULTS
  The treatment of middle-aged patients with dislocated fractures should be based on rational decision-making. The patient's level of activity before the accident should be judged in terms of his or her previous mobility, independence in daily activities, and mental status. Internal fixation is recommended if the fracture can be adequately repositioned, the bone is of good quality, and there is no evidence of osteoarthritis. Fractures that are more than 24 hours old should be treated with total hip arthroplasty. Hemiprostheses are appropriate for very old patients. Physically frail, bedridden, and/or demented patients should undergo internal fixation of the fracture. For non-displaced or impacted fractures, functional treatment (i.e., prophylactic securing of the fracture with screws or nails) is indicated. Rapid diagnosis and a short time in bed before surgery lower the rate of complications. Internal fixation with preservation of the femoral head should ideally be performed within the first 6 hours of trauma, and within the first 24 hours at most.
  
  
  CONCLUSIONS
  Despite the increasing scarcity of resources, treatment should still be based on well-founded clinical guidelines. Minimally invasive surgery enables better function in the early postoperative phase and can thereby lower complication rates. An interdisciplinary concept for the postoperative care of elderly patients also has a major effect on the outcome.
authors.affiliation: Asklepios Klinikum Bad Abbach, Orthopädische Klinik für die Universität Regensburg, Bad Abbach, Germany. ernst.sendtner@web.de
authors.forename: Ernst
authors.initials: E
authors.lastname: Sendtner
authors.forename: Tobias
authors.initials: T
authors.lastname: Renkawitz
authors.forename: Peter
authors.initials: P
authors.lastname: Kramny
authors.forename: Michael
authors.initials: M
authors.lastname: Wenzl
authors.forename: Joachim
authors.initials: J
authors.lastname: Grifka
mesh_terms: D000359:Aftercare; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D001858:Bone Nails; D001863:Bone Screws; D015331:Cohort Studies; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D019317:Evidence-Based Medicine; D005265:Femoral Neck Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods*; D005858:Germany; D019983:Guideline Adherence; D017052:Hospital Mortality; D006801:Humans; D008875:Middle Aged; D011859:Radiography