Femoral neck fractures: a changing paradigm.
Surgical interventions consisting of internal fixation (IF) or total hip replacement (THR) are required to restore patient mobility after hip fractures. Conventionally, this decision was based solely upon the degree of fracture displacement. However, in the last ten years, there has been a move to incorporate patient characteristics into the decision making process. Research demonstrating that joint replacement renders superior functional results when compared with IF, in the treatment of displaced femoral neck fractures, has swayed the pendulum in favour of THR. However, a high risk of dislocation has always been the concern. Fortunately, there are newer technologies and alternative surgical approaches that can help reduce the risk of dislocation. The authors propose an algorithm for the treatment of femoral neck fractures: if minimally displaced, in the absence of hip joint arthritis, IF should be performed; if arthritis is present, or the fracture is displaced, then THR is preferred.
Hospital for Special Surgery, Adult Reconstruction and Joint Replacement Division Hospital for Special Surgery, 535 East 70th Street, New York, 10021, USA.
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Department of Orthopaedic Surgery, St. Joseph's Regional Medical Center, 703 Main Street, Patterson, New Jersey 07503, USA.
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D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D005265:Femoral Neck Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods*; D006622:Hip Prosthesis; D006801:Humans; D011859:Radiography
Femoral neck fracture; Hip fracture; Arthroplasty; Internal fixation; Algorithm