Summary. Femoral neck fractures are a commonly encountered injury in orthopedic practice and result in significant morbidity and mortality. It is essential that surgeons are able to recognize specific fracture patterns and patient characteristics that indicate the use of particular implants and methods to effectively manage these injuries. The use of the Garden and Pauwels classification systems has remained the practical mainstay of femoral neck fracture characterization that help choosing appropriate treatment. Operative options include in situ fixation, closed or open reduction and internal fixation, hemiarthroplasty, and total hip arthroplasty. Recent reports demonstrate diversity among orthopedic surgeons in regard to the optimal treatment of femoral neck fractures and changing trends in their management.
National hospital discharge survey (NHDS), National Center for Health
Statistics. Available at: http://22.214.171.124/hdi/ReportFolders/ReportFolders.aspx?IF_ActivePath=P,18External. Accessed December 31, 2014.
Gullberg B, Johnell O, Kanis JA. World-wide projections for hip fracture. Osteoporos Int. 1997; 7: 407–413. DOI: 10.1007/pl00004148.
Jordan KM, Cooper C. Epidemiology of osteoporosis. Best Pract Res Clin Rheumatol. 2002; 16: 795–806. DOI: 10.1053/berh.2002.0264.
Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006; 17:1726–1733. DOI: 10.1007/s00198-006-0172-4.
Heikal S, Riou P, Jones L. The use of computed tomography in iden- tifying radiologically occult hip fractures in the elderly. Ann R Coll Surg Engl. 2014; 96:234–237. DOI: 10.1308/003588414x13824511650533
Hakkarinen DK, Banh KV, Hendey GW. Magnetic resonance imaging identifies occult hip fractures missed by 64-slice computed tomography. J Emerg Med. 2012; 43:303–307. DOI: 10.1016/j.jemermed.2012.01.037
Gaspar D, Crnkovic T, Durovic D, et al. AO group, AO subgroup, Garden and Pauwels classification systems of femoral neck fractures: are they reliable and reproducible? Med Glas (Zenica). 2012;9:243–247.
Kim JW, Byun SE, Chang JS. The clinical outcomes of early internal fixation for undisplaced femoral neck fractures and early full weight- bearing in elderly patients. Arch Orthop Trauma Surg. 2014; 134: 941–946. DOI: 10.1007/s00402-014-2003-y
AAOS evidence-based guidelines for management of hip fractures in the elderly, adopted by the American Academy of Orthopaedic Surgeons Board of Directors September 5, 2014. Available at: http://www.aaos.org/Research/guidelines/HipFxGuideline.pdf. Accessed December 31, 2014.
Bjorgul K, Reikeras O. Outcome of undisplaced and moderately dis- placed femoral neck fractures. Acta Orthop. 2007; 78: 498–504. DOI: 10.1080/17453670710014149
Papanastassiou ID, Mavrogenis AF, Kokkalis ZT, et al. Fixation of femoral neck fractures using divergent versus parallel cannulated screws. J Long Term Eff Med Implants. 2011; 21: 63–69. DOI: 10.1615/jlongtermeffmedimplants.v21.i1.50
Bishop JA, Behn AW, Castillo TN. The biomechanical significance of washer use with screw fixation. J Orthop Trauma. 2014; 28:114–117. DOI: 10.1097/bot.0b013e31829f9805
Gjertsen JE, Fevang JM, Matre K, et al. Clinical outcome after undisplaced femoral neck fractures. Acta Orthop. 2011; 82:268–274. DOI: 10.3109/17453674.2011.588857
Kain MS, Marcantonio AJ, Iorio R. Revision surgery occurs frequently after percutaneous fixation of stable femoral neck fractures in elderly patients. Clin Orthop Relat Res. 2014; 472:4010–4014. DOI: 10.1007/s11999-014-3957-3
Lapidus LJ, Charalampidis A, Rundgren J, et al. Internal fixation of garden I and II femoral neck fractures: posterior tilt did not influence the reoperation rate in 382 consecutive hips followed for a minimum of 5 years. J Orthop Trauma. 2013; 27:386–390; discussion 90–91. DOI: 10.1097/bot.0b013e318281da6e
Parker MJ, Raghavan R, Gurusamy K. Incidence of fracture-healing complications after femoral neck fractures. Clin Orthop Relat Res. 2007; 458:175–179. DOI: 10.1097/blo.0b013e3180325a42
Stiasny J, Dragan S, Kulej M, et al. Comparison analysis of the operative treatment results of the femoral neck fractures using side-plate and compression screw and cannulated AO screws. Ortop Traumatol Rehabil. 2008;10:350–361.
Bray TJ. Femoral neck fracture fixation. Clinical decision making. Clin Orthop Relat Res. 1997; 339:20–31. DOI: 10.1097/00003086-199706000-00004
Saglam N, Kucukdurmaz F, Kivilcim H, et al. Biomechanical comparison of antirotator compression hip screw and cannulated screw fixations in the femoral neck fractures. Acta Orthop Traumatol Turc. 2014; 48:196–201. DOI: 10.3944/aott.2014.3159
Pervez H, Parker MJ, Vowler S. Prediction of fixation failure after sliding hip screw fixation. Injury. 2004; 35: 994–998.DOI: 10.1016/j.injury.2003.10.028
Parker M, Cawley S, Palial V. Internal fixation of intracapsular fractures of the hip using a dynamic locking plate: two-year follow-up of 320 patients. Bone Joint J. 2013;95-B(10):1402–1405. DOI: 10.1302/0301-620x.95b10.31511
Eschler A, Brandt S, Gierer P, et al. Angular stable multiple screw fixation (Targon FN) versus standard SHS for the fixation of femoral neck fractures. Injury. 2014; 45 (suppl 1):S76–S80. DOI: 10.1016/j.injury.2013.10.026.
Thein R, Herman A, Kedem P, et al. Osteosynthesis of unstable intra- capsular femoral neck fracture by dynamic locking plate or screw fixation: early results. J Orthop Trauma. 2014; 28: 70–76. DOI: 10.1097/bot.0b013e3182a225fa
Zielinski SM, Keijsers NL, Praet SF, et al. Femoral neck shortening after internal fixation of a femoral neck fracture. Orthopedics. 2013; 36: e849–e858.
Kunapuli SC, Schramski MJ, Lee AS, et al. Biomechanical analysis of augmented plate fixation for the treatment of vertical shear femoral neck fractures. J Orthop Trauma. 2014 [epub ahead of print].
Berkes MB, Little MT, Lazaro LE, et al. Catastrophic failure after open reduction internal fixation of femoral neck fractures with a novel locking plate implant. J Orthop Trauma. 2012; 26: e170–e176. DOI: 10.1097/bot.0b013e31823b4cd1.
Bedi A, Karunakar MA, Caron T, et al. Accuracy of reduction of ipsilateral femoral neck and shaft fractures–an analysis of various internal fixation strategies. J Orthop Trauma. 2009; 23: 249–253. DOI: 10.1097/bot.0b013e3181a03675.
Ly TV, Swiontkowski MF. Treatment of femoral neck fractures in young adults. J Bone Joint Surg Am. 2008; 90: 2254–2266.
Collinge CA, Mir H, Reddix R. Fracture morphology of high shear angle “vertical” femoral neck fractures in young adult patients. J Orthop Trauma. 2014; 28:270–275. DOI: 10.1097/bot.0000000000000014.
Wang W, Wei J, Xu Z, et al. Open reduction and closed reduction internal fixation in treatment of femoral neck fractures: a meta-analysis. BMC Musculoskelet Disord. 2014; 15:167. DOI: 10.1186/1471-2474-15-167
Heetveld MJ, Rogmark C, Frihagen F, et al. Internal fixation versus arthroplasty for displaced femoral neck fractures: what is the evidence? J Orthop Trauma. 2009; 23: 395–402. DOI: 10.1097/bot.0b013e318176147d.
Miller BJ, Callaghan JJ, Cram P, et al. Changing trends in the treatment of femoral neck fractures: a review of the American board of orthopaedic surgery database. J Bone Joint Surg Am. 2014; 96: e149.
Parvizi J, Ereth MH, Lewallen DG. Thirty-day mortality following hip arthroplasty for acute fracture. J Bone Joint Surg Am. 2004; 86-A(9): 1983–1988.
Viberg B, Overgaard S, Lauritsen J, et al. Lower reoperation rate for cemented hemiarthroplasty than for uncemented hemiarthroplasty and internal fixation following femoral neck fracture: 12-to 19-year follow- up of patients aged 75 years or more. Acta Orthop. 2013; 84: 254–259. DOI: 10.3109/17453674.2013.792033.
Bell KR, Clement ND, Jenkins PJ, et al. A comparison of the use of uncemented hydroxyapatite-coated bipolar and cemented femoral stems in the treatment of femoral neck fractures: a case-control study. Bone Joint J. 2014; 96-B (3): 299–305. DOI: 10.1302/0301-620x.96b3.32271.
Langslet E, Frihagen F, Opland V, et al. Cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures: 5-year follow-up of a randomized trial. Clin Orthop Relat Res. 2014; 472:1291–1299. DOI: 10.1007/s11999-013-3308-9.
Rogmark C, Fenstad AM, Leonardsson O, et al. Posterior approach and uncemented stems increases the risk of reoperation after hemiarthroplasties in elderly hip fracture patients. Acta Orthop. 2014; 85:18–25.
Krishnan H, Krishnan SP, Blunn G, et al. Modular neck femoral stems. Bone Joint J. 2013; 95-B(8):1011–1021. DOI: 10.1302/0301-620x.95b8.31525
Shulman RM, Zywiel MG, Gandhi R, et al. Trunnionosis: the latest culprit in adverse reactions to metal debris following hip arthroplasty. Skeletal Radiol. 2014 [epub ahead of print]. DOI: 10.1007/s00256-014-1978-3
Liu Y, Tao X, Wang P, et al. Meta-analysis of randomised controlled trials comparing unipolar with bipolar hemiarthroplasty for displaced femoral-neck fractures. Int Orthop. 2014;38:1691–1696. DOI: 10.1007/s00264-014-2355-5
Kanto K, Sihvonen R, Eskelinen A, et al. Uni-and bipolar hemiarthroplasty with a modern cemented femoral component provides elderly patients with displaced femoral neck fractures with equal functional outcome and survivorship at medium-term follow-up. Arch Orthop Trauma Surg. 2014; 134:1251–1259.
Leonardsson O, Karrholm J, Akesson K, et al. Higher risk of reoperation for bipolar and uncemented hemiarthroplasty. Acta Orthop. 2012; 83:459–466.
Fisher MA, Matthei JD, Obirieze A, et al. Open reduction internal fixation versus hemiarthroplasty versus total hip arthroplasty in the elderly: a review of the National surgical Quality Improvement Program database. J Surg Res. 2013; 181:193–198. DOI: 10.1016/j.jss.2012.07.004.
Burgers PT, Van Geene AR, Van den Bekerom MP, et al. Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures in the healthy elderly: a meta-analysis and systematic review of randomized trials. Int Orthop. 2012; 36:1549–1560. DOI: 10.1007/s00264-012-1569-7.
Carroll C, Stevenson M, Scope A, et al. Hemiarthroplasty and total hip arthroplasty for treating primary intracapsular fracture of the hip: a systematic review and cost-effectiveness analysis. Health Technol Assess. 2011;15: 1–74.
Hedbeck CJ, Enocson A, Lapidus G, et al. Comparison of bipolar hemi- arthroplasty with total hip arthroplasty for displaced femoral neck fractures: a concise four-year follow-up of a randomized trial. J Bone Joint Surg Am. 2011;93:445–450. DOI: 10.2106/jbjs.j.00474.
Tidermark J, Zethraeus N, Svensson O, et al. Quality of life related to fracture displacement among elderly patients with femoral neck fractures treated with internal fixation. 2002. J Orthop Trauma. 2003; 17 (8 suppl): S17–S21. DOI: 10.1097/00005131-200309001-00005
Augat P., Bliven E., Eng M., Hackl S. Biomechanics of Femoral Neck Fractures and Implications for Fixation. J Orthop Trauma 2019;33:S27–S32. DOI: 10.1097/bot.0000000000001365
Medda S., Snoap N., Carroll E. Treatment of Young Femoral Neck Fractures. J Orthop Trauma 2019;33:S1–S6. DOI: 10.1097/bot.0000000000001369
This work is licensed under a Creative Commons Attribution 4.0 International License.