I feel like I'm on medical Let's Make a Deal. I have a badly broken femoral neck fracture. I've been given the choice of door number one: internal fixation, door number two: hemiarthroplasty, or door number three: total hip replacement. I'm a relatively young (62-year old) corporate executive. I need to get back on my feet as fast as possible. What do the experts say I should do?
There are two basic types of femoral neck fractures: nondisplaced and displaced. Nondisplaced means the bone is broken but the fracture line has not separated. Displaced refers to the fact that the two sides of the broken bone have moved apart and no longer line up. Since you describe yourself as having a badly broken leg, we are assuming you have a displaced femoral neck fracture.
Of the choices you mentioned, internal fixation (compared to hemiarthroplasty) has a faster surgical time, less blood loss and lower infection rate. However, a second (revision) surgery is more common after internal fixation (40 per cent compared to only five percent with hemiarthroplasty). And the incidence of nonunion and osteonecrosis (death of bone) is higher with internal fixation.
The mortality (death) rate is usually something doctors pay close attention to. But this is more important for adults aged 65 and older. Studies show that the complication rates are lower and hip function is higher among patients with a total hip replacement (compared to internal fixation).
For younger patients, if a complete hip replacement isn't needed, then hemiarthroplasty is the next best option. At that point, there are other decisions to be made as well. What type of hemiarthroplasty hould the surgeon use? The two main types are unipolar and bipolar. Each has its pros and cons. And whould they be put in with or without fixation (cemented versus cementless).
These and other considerations can complicate the care of femoral neck fractures. Your surgeon is the best one to advise you in this matter. His or her experience, familiarity, and comfort level with each of these procedures is important. But so are various factors centered around you and your health. Your age, general health, mental status, and function before the fracture are taken into consideration. Type, severity, and location of the fracture must also be reviewed.
Ryan G. Miyamoto, MD, et al. Surgical Management of Hip Fractures: An Evidence-Based Review of the Literature. I: Femoral Neck Fractures. In Journal of the American Academy of Orthopaedic Surgeons. October 2008. Vol. 16. No. 10. Pp. 596-607.
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