[The treatment of femoral neck fractures].
BACKGROUND
About 5000 people fracture their femoral neck every year in Norway. Mean age is about 83 years and about 3/4 are women. For more than 50 years the alternatives have been internal fixation or arthroplasty. In Norway, the tradition has been internal fixation. Recent studies, however, support the use of arthroplasty. The article provides a review on the treatment of femoral neck fractures.


METHODS
The article is based on literature identified through a non-systematic search in Medline.


RESULTS
Internal fixation has a higher risk of treatment failure (30 - 40 % in displaced fractures) than arthroplasty (less than 10 %). In elderly patients with displaced fractures, arthroplasty provides better hip function than internal fixation. Most patients should be treated with hemiarthroplasty, but total hip arthroplasty may give better function in the healthiest and fittest of the elderly patients. In patients younger than 60 - 65 years, internal fixation should be attempted, even though the failure rate is about 30 %. Undisplaced fractures should be treated with internal fixation, irrespective of age. The risk of treatment failure is about 10 %.


CONCLUSIONS
Elderly patients with displaced femoral neck fractures should be treated with arthroplasty, usually hemiarthroplasty. Osteosynthesis should normally be reserved for undisplaced fractures and fractures in young and otherwise healthy patients.
Frihagen
Frede
F
Ortopedisk avdeling, Oslo universitetssykehus, Ullevål 0407 Oslo, Norway. j.f.frihagen@medisin.uio.no
Figved
Wender
W
Madsen
Jan Erik
JE
Lofthus
Cathrine M
CM
Støen
Ragnhild Øydna
RØ
Nordsletten
Lars
L
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001178:Arthroplasty; D019644:Arthroplasty, Replacement, Hip; D005260:Female; D005265:Femoral Neck Fractures / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D005593:Fracture Fixation, Internal / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D017211:Treatment Failure