title: Subcapital fractures: a changing paradigm.
abstract: Options for the treatment of subcapital femoral   neck fractures basically fall into two categories: internal fixation   or arthroplasty (either hemiarthroplasty or total hip arthroplasty).   Historically, the treatment option has been driven by a diagnosis-related approach   (non-displaced neck fractures versus displaced neck fractures).   More recently, the traditional paradigm has changed. Instead of   a diagnosis-related approach, it has become more of a patient-related   approach. Treatment options take in to consideration the patient's age,   functional demands, and individual risk profile. A simple algorithm   can be helpful in terms of directing the treatment. Non-displaced   fractures, regardless of age of the patient, should be treated with   closed reduction and internal fixation. For displaced femoral neck fractures,   the treatment differs depending on the age of the patient. The younger   patient should be treated with urgent ORIF with the goal of an anatomic   reduction. For displaced femoral neck fractures in the elderly,   cognitive function should be determined. For those who are cognitively   functioning, total hip arthroplasty appears to be the best option.   In the cognitively dysfunctional, a bipolar hemiarthroplasty or   a total hip arthroplasty with use of larger heads (32 mm or 36 mm)   and/or constrained sockets are a viable option.
authors.affiliation: University of Iowa, P O Box 2282, Iowa City, Iowa 52244, USA. johncallaghan@uiowa.edu
authors.forename: J J
authors.initials: JJ
authors.lastname: Callaghan
authors.forename: S S
authors.initials: SS
authors.lastname: Liu
authors.forename: G J
authors.initials: GJ
authors.lastname: Haidukewych
mesh_terms: D000367:Age Factors; D000465:Algorithms; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D003661:Decision Support Techniques; D005265:Femoral Neck Fractures / Q000175:diagnosis / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods*; D006305:Health Status Indicators; D006801:Humans; D018570:Risk Assessment