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Review
. 2014 Jul 18;5(3):204-17.
doi: 10.5312/wjo.v5.i3.204.

Management of femoral neck fractures in the young patient: A critical analysis review

Thierry Pauyo  1 , Justin Drager  1 , Anthony Albers  1 , Edward J Harvey  1
Affiliations
Review

Management of femoral neck fractures in the young patient: A critical analysis review

Thierry Pauyo et al. World J Orthop. .

Abstract

Femoral neck fractures account for nearly half of all hip fractures with the vast majority occurring in elderly patients after simple falls. Currently there may be sufficient evidence to support the routine use of hip replacement surgery for low demand elderly patients in all but non-displaced and valgus impacted femoral neck fractures. However, for the physiologically young patients, preservation of the natural hip anatomy and mechanics is a priority in management because of their high functional demands. The biomechanical challenges of femoral neck fixation and the vulnerability of the femoral head blood supply lead to a high incidence of non-union and osteonecrosis of the femoral head after internal fixation of displaced femoral neck fractures. Anatomic reduction and stable internal fixation are essentials in achieving the goals of treatment in this young patient population. Furthermore, other management variables such as surgical timing, the role of capsulotomy and the choice of implant for fixation remain controversial. This review will focus both on the demographics and injury profile of young patients with femoral neck fractures and the current evidence behind the surgical management of these injuries as well as their major secondary complications.

Keywords: Capsulotomy; Femoral neck fracture; Osteonecrosis; Surgical timing; Young patient.

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Figures

Figure 1
Figure 1
Garden classification. A: Incomplete fracture of the femoral neck with valgus impacon. Note the radiopaque overlap of the femoral neck and head; B: Displaced complete fracture of the femoral neck; C: Less than 50% displacement of a complete fracture of the femoral neck; D: Complete fracture of the femoral neck with complete displacement.
Figure 2
Figure 2
Cannulated screw fixation. A: Anterior posterior view; B: Anterior posterior view with cannulated screw.
Figure 3
Figure 3
Dynamic hip screw fixation. A: Anterior posterior view with 2 holes 135° dynamic hip screw; B: Lateral view of 2 holes 135° dynamic hip screw.
Figure 4
Figure 4
Dynamic hip screw with derotation screw. A: Anterior posterior view pre-operative of 4 holes 145° dynamic hip screw; B: Lateral view pre-operative of 4 holes 145° dynamic hip screw.
See this image and copyright information in PMC

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