I need some advice in a hurry. My wife fell and broke her hip. They tell me it’s a break in the femoral neck and a team of surgeons are asking me to make the final decision about what to do. Do we want to fix the break with a bunch of screws holding it all together? Or should we go with a hip replacement. I know the decision isn’t all on my shoulders because the chief orthopedic surgeon is going to make her recommendation. What can you tell me that might help?

There are different types of hip fractures based on location. Femoral neck fractures are just one type of several different hip fractures. The femur is the long thigh bone with a round bony “head” at the top. The femoral head fits inside the acetabulum or hip socket.

Fractures can occur anywhere in the long shaft of the femur, the neck (between the shaft and the femoral head), and the acetabulum. There is also intertrochanteric fractures. The intertrochanteric region of the hip is just below the femoral neck.

Two of the major problems that develop with femoral neck fractures are loss of blood to the femoral head and shortening of the femoral neck. Unless the patient cannot tolerate surgery for some reason, femoral fractures are best treated surgically. And the most common choices are as you described: internal fixation with metal plates, screws, pins, and/or wires or hip replacement.

Fixation is available to a limited number of patients. The fracture must be stable. If displaced (separated), it must be possible to bring the pieces together and precisely match them up again. If the surgeon sees reasons and predictive factors that point to the strong possibility of nonunion and failed fixation, then hip replacement is the treatment of choice.

Older adults who are active and wish to remain active may prefer this approach as well. It bypasses the possibility of a second surgery (from fixation to replacement). Current studies show fixation failure at 25 per cent right now.

Results of total hip replacement (measured by pain, function, and revision rates) have been good-to-excellent for the “active and fit” older adults. Benefits and risks of this surgery for this age group with femoral neck fractures are still being investigated and reported.

No doubt the surgeon will go over the pros and cons of each treatment option (if she hasn’t already). The final decision is usually left to the surgeon once the hip has been opened up and it’s possible to take a look at the full extent of the damage. Having the patient’s preferences known is a key factor but not the only one.