Treatment for Displaced Femoral Neck FracturesIn this article, Dr. Iorio from the Lahey Clinic in Massachusetts reviews treatment options for displaced fractures of the femoral neck. The femoral neck is the bridge of bone between the long shaft of the femur (thigh bone) and the round head at the top that fits into the hip socket.
A displaced fracture means the bones on either side of the break have shifted. In order for good healing to occur, the fracture lines must be lined up or the bones replaced. Surgery is needed to accomplish repair or reconstruction.
Repairing the break is referred to as reduction with internal fixation. Metal plates, screws, nails and/or wires are used to fix or hold the bones in place until they knit together. In the case of reconstruction, a total hip replacement (THR) is done.
The choice of treatment depends on several factors. Age and general health are two main considerations. Young, healthy, active adults with good bone stock are usually treated with reduction repair. The best choice may not be so easy to determine for older adults.
There are many factors to consider. Was the patient able to walk before the fracture? Would a repair or reconstruction be more likely to get the patient back up on his or her feet? Cost for each method of management must be considered. Does the patient have the mental ability to follow directions and complete a rehab program?
Once the decision is made regarding reduction or replacement, the surgeon faces another series of decisions. What kind of surgical technique should be used? What kind of internal fixation would give the most stable hip? If a THR is going to be done, should it be with or without cement? What type of implant would be best?
The author advises a THR for most displaced femoral neck fractures in the elderly. For those who are good candidates, the THR gives the best chance for regaining function and maintaining independence. In the long run, THR is more cost effective compared with reduction surgery.
Patients who have dementia, confusion, or other mental handicaps should have a hemiarthroplasty. In such cases, just the femoral head and neck are replaced. The acetabulum (hip socket) is not replaced.
Richard Iorio, MD. Primary Total Hip Replacement in Patients with Displaced Femoral Neck Fractures. In Current Opinion in Orthopaedics. January 2008. Vol. 19. No. 1. Pp. 28-32.
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