[Fracture of the medial femoral neck: is there still a place for conservative treatment?]

Abstract

Non-displaced fractures of the femoral neck are generally internally fixated while preserving the femoral head. The current guideline states that conservative treatment of non-displaced (impacted) femoral neck fractures may be considered in patients with a 'healthy' patient profile and in patients who have already borne weight on the broken hip. This literature review shows that conservative treatment of patients with impacted hip fractures fails in approximately 30% of the cases. In most cases, patients in whom conservative treatment has failed will receive a femoral neck prosthesis or total hip replacement. The placement of femoral neck prosthesis has a higher surgical and anaesthesiological risk compared to internal fixation of the non-displaced femoral neck fracture. Given the quality of surgical techniques and improvement in perioperative care, the operative risk is limited and direct internal fixation should be strongly considered for non-displaced femoral neck fractures in all patients whose life expectancy is longer than 2 weeks.