Management of femoral neck fractures in the young patient: A critical analysis review

Abstract

Femoral neck fractures account for nearly half of all hip fractures with the vast majority occurring in elderly patients after simple falls. Currently there may be sufficient evidence to support the routine use of hip replacement surgery for low demand elderly patients in all but non-displaced and valgus impacted femoral neck fractures. However, for the physiologically young patients, preservation of the natural hip anatomy and mechanics is a priority in management because of their high functional demands. The biomechanical challenges of femoral neck fixation and the vulnerability of the femoral head blood supply lead to a high incidence of non-union and osteonecrosis of the femoral head after internal fixation of displaced femoral neck fractures. Anatomic reduction and stable internal fixation are essentials in achieving the goals of treatment in this young patient population. Furthermore, other management variables such as surgical timing, the role of capsulotomy and the choice of implant for fixation remain controversial. This review will focus both on the demographics and injury profile of young patients with femoral neck fractures and the current evidence behind the surgical management of these injuries as well as their major secondary complications.

Should full threaded compression screws be used in adult femoral neck fractures?

“…There are several biomechanical constructs available for the fixation of femoral neck fractures and knowing when and how to position the implant is paramount to attain a stable fixation. Compression screws (CS) and fixed-angle dynamic implants, or a combination of both, promote union during weight bearing by allowing the fracture fragments to slide along the implant while being axially loaded [20]. The use of the multiple compressive screws has been advocated for Garden types 1 and 2 in attaining union [30,31].…”

“…The biomechanical challenges of femoral neck fixation and the vulnerability of the femoral head blood supply lead to a high incidence of non-union and osteonecrosis of the femoral head after internal fixation of displaced femoral neck fractures [21]. These complications are highly symptomatic in active patients leading to salvage procedures with significant failure rates [20]. Lately, the etiology of complications, type of fixation and outcomes of neck of femur fractures in the adult population has had a lot of attention [22][23][24][25][26][27].…”

“…Currently, there may be sufficient evidence to support the routine use of hip replacement surgery in fit active elderly patients except those with non-displaced and valgus impacted fracture patterns. However, for the physiologically young patients, preservation of the natural hip anatomy and mechanics is a priority in management because of their high functional demands [20]. The biomechanical challenges of femoral neck fixation and the vulnerability of the femoral head blood supply lead to a high incidence of non-union and osteonecrosis of the femoral head after internal fixation of displaced femoral neck fractures [21].…”

Collumfracturen bij wielrenners

“…Dit verhoogt de rotatiestabiliteit van de fixatie. 12,15 Bij het plaatsen van een dynamische heupschroef dient het spinnen van de femurkop altijd voorkomen te worden middels controle onder doorlichting en eventueel het plaatsen van een K-draad. In tegenstelling tot bij de oudere patient dient minder snel een totale heupprothese (en zeker geen hemiprothese) geplaatst te worden.…”

Case Series of Four Quadrant Parallel Peripheral Screw Fixations for Fractured Neck of Femur and Their Outcome

“…The unstable fractures -namely Pauwel's type III or Garden's type III and IV -are seen in young adults more frequently; treating which is more difficult because of the instability, increased shear force, varus movement and because of these they have a higher risk of fixation failure, malunion, non-union and osteonecrosis. 4,5,6 The treatment of intracapsular neck femur fracture has undergone many changes. Nowadays, the surgical treatment of femoral neck fracture consists of various options: a) Closed or Open Reduction with Internal Fixation of the fracture, b) Hemiarthroplasty, or c) Total Hip Arthroplasty.…”