Fractures of the femoral neck.

Fractures of the femoral neck are increasing at an exponential rate as a result of the longevity of the general population. The Garden and Pauwels classifications both are routinely used to describe displacement and stability of femoral neck fractures. Osteonecrosis and nonunion remain problematic because of the compromised blood supply to the femoral head in displaced fractures. Nondisplaced fractures and displaced fractures in patients physiologically younger than 65 years are treated with closed or open reduction and internal fixation. Anatomic reduction is the single most important step in the treatment and fixation of these difficult fractures. Because of the higher complication rate in patients physiologically older than 65 years, a prosthetic replacement may be considered for the treatment of displaced fractures. In patients who are low-level community ambulators or nursing home ambulators with comorbidities and who are not expected to live more than 5 years after injury, a hemiprosthesis is indicated. In active, elderly patients physiologically older than 65 years who are expected to live longer than 5 years after injury, a total hip replacement is the treatment of choice. Total hip replacement relieves pain and allows faster rehabilitation than other forms of treatment in this age group. Patients with preexisting hip disease also are treated with total hip replacement. An algorithm that considers physiologic age and activity level of the patient is helpful when deciding whether to fix or replace the hip in a patient with a displaced femoral neck fracture. It is also useful in deciding what type of prosthesis to use. The treatment of femoral neck fractures remains complex and difficult. Because of the enormous burden of this injury, orthopaedists must improve results in the care of femoral neck fractures.