Displaced femoral neck fractures in adult and elderly patients, pitfalls in treatment options: internal fixation or replacement?

The incidence of hip fractures is steadily increasing. The treatment of displaced femoral neck fractures is controversial. The principal area of disagreement is whether to reduce the fracture and use internal fixation or to perform a total or partial hip replacement. Especially in Scandinavia, primary osteosynthesis, irrespective of age, has been the method of choice for decades with an 80% success rate. Even the supporters of osteosynthesis report a high percentage of non-union (20-25%) mainly due to failures in the elderly. Undoubtedly, younger patients and those with minimally displaced fractures should be treated by internal fixation in an attempt to preserve the natural hip joint. Hemiarthroplasty appears to be best suited for the elderly. The ‘gray-zone’ in between the two distinct patient populations is the subject of much controversy. Özet The incidence of hip fractures is steadily increasing. The treatment of displaced femoral neck fractures is controversial. The principal area of disagreement is whether to reduce the fracture and use internal fixation or to perform a total or partial hip replacement. Especially in Scandinavia, primary osteosynthesis, irrespective of age, has been the method of choice for decades with an 80% success rate. Even the supporters of osteosynthesis report a high percentage of non-union (20-25%) mainly due to failures in the elderly. Undoubtedly, younger patients and those with minimally displaced fractures should be treated by internal fixation in an attempt to preserve the natural hip joint. Hemiarthroplasty appears to be best suited for the elderly. The ‘gray-zone’ in between the two distinct patient populations is the subject of much controversy.