The effect of femoral neck fractures on femoral head blood flow.

Treatment of femoral neck fractures remains a significant clinical challenge. The choice between femoral head replacement and internal fixation must take into account the patient's age, activity level, degree of osteoporosis, and medical condition. If open reduction and internal fixation is chosen, an understanding of the vascular pathophysiology of femoral neck fractures is helpful to insure the best clinical result. Osteonecrosis of the femoral head and non-union of the femoral neck fracture are the two most common complications following fixation of a femoral neck fracture. The vascular damage from the fracture itself significantly reduces femoral head perfusion. Therefore, a careful and anatomic (or slightly valgus) reduction, followed by rigid fixation with three pins, three screws, or a hip screw construct, is advised. There is experimental and clinical evidence that "emergent" open reduction and internal fixation and capsulotomy may lessen the vascular insult from the femoral neck fracture itself.