Highlights
- •A case-to-case analysis of the patient-related key points helps the surgeon to reduce the complications after femoral neck fractures (FNF).
- •These key points are: age, timing, comorbidities, bone quality, head vascularization, displacement, intrinsic instability, and comminution.
- •An anatomical reduction followed by a stable fixation is mandatory in order to allow early mobilization, the main goal for elderly patients.
- •Total hip arthroplasty for FNF is gaining popularity even among older patients if previously active and without severe comorbidities.
Abstract
Introduction
Femoral neck fractures (FNF) are frequent injuries and not rarely complicated by non-union,
implant failure, and avascular necrosis. Some of these fractures represent a dilemma
for trauma surgeons. Which fracture should be fixed? Which replaced with a prosthesis?
How? The aim of this narrative review is to investigate the literature in order to
provide the most updated and evidence-based knowledge about FNF’ treatment.
Materials and methods
A literature research has been performed to find the essential key points to consider
when dealing with FNF and their treatment. The most representative papers and the
new meta-analysis were matched with authors’ experience to give a concise but comprehensive
view of the problem. Timing, age, comorbidities, vascularization of the femoral head,
displacement, instability, comminution of the fracture, bone quality, and surgeon
experience seem to be the major topics to consider in the decision making. We then
focus on the optimal fixation or replacement as suggested by the literature.
Results
Age is the main independent factor to consider. Timing seems essential in the elderly
population to reduce mortality and important in the younger patients to reduce complications.
Vascular supply should be always considered. Displacement, instability, and comminution
of the fracture are negative prognostic factors for fixation as well as, theoretically,
bone quality. In the elderly hip replacement is mostly indicated. A stable and solid
fixation is mandatory to allow early mobilization. Sliding Hip Screws (SHS) seem preferable
to cannulated screws for displaced/unstable (Pauwels II-III, posterior comminution)
and basicervical fracture patterns or in smokers. There is a tendency toward Total
Hip Arthroplasty (THA) also in the elderly if the patient is an indipendent ambulator
without severe comorbidities. Dual mobility cups are gaining popularity in THA for
FNF.
Conclusions
FNF are frequent injuries and represent, in some cases, a dilemma for the trauma surgeon.
Age, timing, comorbidities, bone quality, femoral head vascularization, fracture displacement,
intrinsic instability, and comminution as surgeon experience should be carefully evaluated
before surgery. A case-to-case analysis of the patient-related factors helps the surgeon
to make the right choice and reduce the well-known complications.
Keywords
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Article info
Publication history
Published online: September 25, 2021
Accepted:
September 12,
2021
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2021 Elsevier Ltd. All rights reserved.
