Surgical Treatment of Femoral Neck Fractures

As the population ages and life expectancy increases, the prevalence of femoral neck fracture has continued to grow. Femoral neck fractures have significant consequences for the geriatric patient population, with 33% mortality within 1 year of surgery and a 35% chance of never ambulating independently following surgery (Dyer et al., BMC Geriatr. 16:158, 2016). The surgical treatment options for this injury include open reduction with internal fixation versus arthroplasty. Non-displaced or valgus-impacted femoral neck fractures may be amenable to closed reduction percutaneous pinning with cannulated screws or a limited open reduction internal fixation using a sliding hip screw. However, due to the increased risk of nonunion, avascular necrosis, and revision surgery following fixation of displaced femoral neck fractures, either hemiarthroplasty or total hip arthroplasty is the mainstay of treatment for these fracture patterns in geriatric patients. The debate over whether to replace or fix minimally displaced femoral neck fractures in the elderly remains a topic of controversy. As for arthroplasty, the decision on whether to perform a hemiarthroplasty or total hip arthroplasty also remains controversial. Younger, more active, and healthier geriatric patients with preexisting hip osteoarthritis may be more appropriate for total hip arthroplasty due to its improved implant survivorship and hip function scores. Patients with significant medical comorbidities, Parkinson’s disease, and decreased functional demand may be better suited for hemiarthroplasty due to the shorter operative duration with decreased blood loss and lower risk of dislocation. There are many implant considerations to take into account when performing arthroplasty in geriatric patients. It is imperative to understand the benefits and risks associated with the use of cemented or cementless femoral components and unipolar and bipolar femoral heads. While there is a limited role for non-operative treatment of acute femoral neck fractures in the geriatric population, all orthopaedic surgeons need to be knowledgeable about the different surgical treatment options, their benefits, and potential complications.