Salvage of failed treatment of femoral neck fractures.

The number of patients treated for femoral neck fractures continues to increase. Although most fractures will heal, reported rates of nonunion and osteonecrosis are cause for concern; therefore, implementation of effective salvage strategies is important. The choice of salvage strategy generally is guided by patient age, remaining bone quality, the status of the articular surface of the hip joint, and the viability of the femoral head. Nonunions in patients younger than 60 years are typically treated with valgus-producing osteotomies, which convert shear forces to compressive forces and have demonstrated relatively high union rates. The role of various vascularized and nonvascularized bone grafts remains undefined. Nonunions in patients older than 60 years are typically salvaged with some form of hip arthroplasty. Both hemiarthroplasty and total hip arthroplasty can be effective. Surgical challenges include osteopenic bone; bony defects from hardware; and contracted, scarred, and shortened limbs. Careful attention to detail during surgery is necessary to avoid complications and provide durable reconstructions in this setting.