Management of femoral neck fractures in the young patient: A critical analysis review

Abstract

Femoral neck fractures account for nearly half of all hip fractures with the vast majority occurring in elderly patients after simple falls. Currently there may be sufficient evidence to support the routine use of hip replacement surgery for low demand elderly patients in all but non-displaced and valgus impacted femoral neck fractures. However, for the physiologically young patients, preservation of the natural hip anatomy and mechanics is a priority in management because of their high functional demands. The biomechanical challenges of femoral neck fixation and the vulnerability of the femoral head blood supply lead to a high incidence of non-union and osteonecrosis of the femoral head after internal fixation of displaced femoral neck fractures. Anatomic reduction and stable internal fixation are essentials in achieving the goals of treatment in this young patient population. Furthermore, other management variables such as surgical timing, the role of capsulotomy and the choice of implant for fixation remain controversial. This review will focus both on the demographics and injury profile of young patients with femoral neck fractures and the current evidence behind the surgical management of these injuries as well as their major secondary complications.

Keywords: Osteonecrosis, Femoral neck fracture, Young patient, Capsulotomy, Surgical timing

Core tip: This critical analysis review provides an overview of the pathophysiology of femoral neck fractures in the young adults. Additionally, it offers recommendations to guide the orthopedic surgeon in the management of femoral neck fractures and its most common surgical complications. Few studies have reviewed this controversial subject and provided treatment guidelines.