Due to the high incidence (600-900 patients/year >65 years old), the expected increase in frequency by a factor of five by 2050, and the proportionately shrinking capacity in trauma centers, femoral neck fractures are relevant to health care both economically and politically. Surgical treatment within 6 h improves results of osteosynthesis, within 24 h reduces general complications, and within 48 h reduces mortality. The literature displays great regional differences in methods and results. There is however general agreement that the hip joint should be preserved in young, active patients, regardless of fracture type and dislocation and that endoprosthesis is desirable for elderly patients with severe dislocation. The controversies begin with compressed fracture, determination of the degree of dislocation, and age and physical condition of patients who would profit from endoprosthesis. Total endoprostheses show better results in more active patients than do hemiarthroconstructions. Cemented endoprostheses are preferable in older patients due to their better function and lower postoperative pain. The DGU recommends prophylactic osteosynthesis for impacted fracture and osteosynthesis for nondislocated fracture or when closely following slightly dislocated fracture.
The ideal treatment of the intracapsular fracture of the femoral neck still is subject of discussion. The demographic development of the population in Europe with fractures of the neck of femur being typical in the older patient, requires conclusive and stringent concepts of treatment. Adequate and patient oriented therapy should be promoted, regional differences and provisional deficiencies need to be adjusted in order to minimize the rate of complications. The guideline "Schenkelhalsfraktur" of the German board of trauma surgeons, the 'Deutsche Gesellschaft für Unfallchirurgie', and the article at hand are meant to serve as a manual for the trauma surgeon. Based on evaluated data it simplifies rational decision-making for treatment of fractures of the proximal femur. Moreover, secondary prophylaxis as well as the subsequent outpatient treatment and the social reintegration of the patients recovering from fractures of the femoral neck remains vitally important. After all, even with ideal treatment of the fracture more than half of the patients are impaired for a long time and one out of four permanently depends on nursing assistance.
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