Femoral Neck Fractures: How to Avoid Failures and Manage Problems

Femoral neck fractures are common injuries sustained by patients of all ages and are caused by both low- and high-energy mechanisms. The physician must diagnose the fracture expeditiously to initiate treatment. The surgeon must then evaluate the patient's medical condition and fracture characteristics to determine a treatment regimen that will minimize the all-too-common risks of osteonecrosis and fixation failure or fracture nonunion. In elderly, frail, and inactive patients, hip arthroplasty is usually the best treatment. In younger patients, efforts should be directed at expedient reduction of the fracture and surgical stabilization with multiple screws or with a sliding compression screw construct. The rationale of proper patient selection and the intraoperative tactics for optimal results are important topics to be reviewed.