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Treatment Options for Femoral Neck Fractures

In this article, orthopedic surgeons review the use and cost of surgical treatment options for a displaced femoral neck fracture. This type of break occurs near the top of the femur (thigh bone) just below the femoral head (round ball) that fits into the hip socket. A displaced fracture means the two ends of bone have shifted and no longer line up on either side of the break.

Hip fractures are a common problem in the aging population. And the number of people over age 65 is going to explode as the baby boomers reach this milestone. More cases of osteoporosis and hip fracture are expected as the human life span keeps increasing.

Surgeons must be prepared to treat these patients. They must choose between repairing the fracture or replacing the hip. There are two main choices in hip implants: partial or complete replacement. The surgeon will have to decide which one is best for each patient.

Repairing the fracture with a plate and screws is called internal fixation. It's a good idea to save the bone whenever possible but many times the fracture doesn't heal in older adults. They end up having a second surgery to replace the joint. Internal fixation is used for patients younger than 65 who have good bone quality.

If the surgeon decides to replace the femoral head, there are three options to choose from: unipolar hemiarthroplasty, bipolar hemiarthroplasty, and total arthroplasty. Unipolar hemiarthroplasty is a partial replacement. For this type of fracture, only the femoral head is replaced.

Bipolar hemiarthroplasty is a partial replacement of the femoral head but it comes in two parts. The natural acetabulum (hip socket) stays but a metal cup lined with polyethylene fits inside the socket. This allows for motion in two places: the new femoral head rotates inside the plastic cup and the cup rotates inside the acetabulum. This type of replacement is not advised for the elderly. The less expensive unipolar hemiarthroplasty works just as well in less active patients who have fewer years to live.

The authors say that a total hip replacement (THR) is the best treatment option for older adults with a displaced femoral neck fracture. It's more durable and gives better function. The cost is less than having a failed internal fixation operation.

When making the final treatment decision, the surgeon may have to rely on the patient's mental status and level of independence and activity. Other factors to consider include the condition of the joint and surrounding bone. Family support and living arrangements are also important factors.

References: William Macaulay, MD, et al. Displaced Femoral Neck Fractures in the Elderly: Hemiarthroplasty Versus Total Hip Arthroplasty. In Journal of the American Academy of Orthopaedic Surgeons. May 2006. Vol. 14. No. 5. Pp. 287-293.

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