Femoral neck fracture fixation. Clinical decision making.

Femoral neck fractures continue to pose significant decision making problems for the busy practitioner. Indirect factors over which the orthopaedic surgeon has little control include the patient's preinjury medical status, metabolic bone quality, and fracture classification. Direct factors that fall on the decision making ability of the surgeon include surgical timing, capsular hematoma, quality of reduction, and mechanics of fixation. Early, rigid anatomic reduction with 6.5-mm compression screws in patients with few comorbidities will achieve the optimum outcomes using fixation techniques. Anterolateral open approaches afford capsular hematoma decompression and anatomic access for fixation in the young or irreducible fracture pattern.