Decision Making in Femoral Neck Fractures: Internal Fixation versus Arthroplasty
Abstract
Femoral neck fracture is a global public health problem with 1.5 million hip fractures per year worldwide. However, there is no current consensus on the choice of ideal treatment. In this study, we aimed to answer the questions of when to choose internal fixation and arthroplasty, whether to do total hip arthroplasty or hemiarthroplasty, whether to use cemented or uncemented prosthesis, and whether to use a bipolar or unipolar design for hemiarthroplasty. We also discussed the complications associated with each method. We attempted to discuss these issues based on the latest literature and also presented the protocol of our institute in each subject.Â
1. Dijkman B, Kooistra B, Ferguson T, Bhandari M. Decision making: Open reduction/internal fixation versus arthroplasty for femoral neck fractures. Tech Orthop. 2008;23(4):288-95. doi: 10.1097/BTO.0b013e318196fb53.
2. Hayat Z, Varacallo M. Surgical management of femoral neck fractures. StatPearls [Internet] Treasure Island (FL): StatPearls Publishing 2020. [PubMed: 30855824].
3. Smith-Petersen MN, CAVE EF, VANGORDER GW. Intracapsular fractures of the neck of the femur: treatment by internal fixation. Arch Surg. 1931;23(5):715-59. doi: 10.1001/archsurg.1931.01160110002001
4. Bhandari M, Devereaux PJ, Swiontkowski MF, Tornetta P 3rd, Obremskey W, Koval KJ, et al. Internal fixation compared with arthroplasty for displaced fractures of the femoral neck. A meta-analysis. J Bone Joint Surg Am. 2003;85(9):1673-81. doi: 10.2106/00004623-200309000-00004. [PubMed: 12954824].
5. Bhandari M, Devereaux PJ, Tornetta P 3rd, Swiontkowski MF, Berry DJ, Haidukewych G, et al. Operative management of displaced femoral neck fractures in elderly patients. An international survey. J Bone Joint Surg Am. 2005;87(9):2122-30. doi: 10.2106/JBJS.E.00535. [PubMed: 16140828].
6. Florschutz AV, Langford JR, Haidukewych GJ, Koval KJ. Femoral neck fractures: Current management. J Orthop Trauma. 2015;29(3):121-9. doi: 1097/BOT.0000000000000291. [PubMed: 25635363].
7. Zielinski SM, Meeuwis MA, Heetveld MJ, Verhofstad MH, Roukema GR, Patka P, et al. Adherence to a femoral neck fracture treatment guideline. Int Orthop. 2013;37(7):1327-34. doi: 10.1007/s00264-013-1888-3. [PubMed: 23595233]. [PubMed Central: PMC3685653].
8. Mathews V, Cabanela ME. Femoral neck nonunion treatment. Clin Orthop Relat Res. 2004;(419):57-64. doi: 10.1097/00003086-200402000-00010. [PubMed: 15021132].
9. Raaymakers EL, Marti RK. Nonunion of the femoral neck: Possibilities and limitations of the various treatment modalities. Indian J Orthop. 2008;42(1):13-21. doi: 10.4103/0019-
5413.38575. [PubMed: 19823649]. [PubMed Central:
PMC2759582].
10. Bhandari M, Tornetta P, III, Hanson B, Swiontkowski MF. Optimal internal fixation for femoral neck fractures: Multiple screws or sliding hip screws? J Orthop Trauma. 2009;23(6): 403-7. doi: 10.1097/BOT.0b013e318176191f. [PubMed: 19550225].
11. Shen M, Wang C, Chen H, Rui YF, Zhao S. An update on the Pauwels classification. J Orthop Surg Res. 2016;11(1):161. doi: 10.1186/s13018-016-0498-3. [PubMed: 27955672]. [PubMed Central: PMC5154085].
12. Bray TJ. Femoral neck fracture fixation. Clinical decision making. Clin Orthop Relat Res. 1997;(339):20-31. doi: 10.1097/00003086-199706000-00004. [PubMed: 9186197].
13. Keating JF, Grant A, Masson M, Scott NW, Forbes JF. Randomized comparison of reduction and fixation, bipolar hemiarthroplasty, and total hip arthroplasty. Treatment of displaced intracapsular hip fractures in healthy older patients. J Bone Joint Surg Am. 2006;88(2):249-60. doi: 10.2106/JBJS.E.00215. [PubMed: 16452734].
14. Leonard M, Alao U, Glynn A, Dolan M. Hip fractures: Failure of fixation and outcome of salvage arthroplasty. Eur J OrthopSurg Traumatol. 2009;19(8):553-8.
15. Liu YJ, Xu B, Li ZY, Zhang Q, Zhang YZ. Quantitative score system for the surgical decision on adult femoral neck
fractures. Orthopedics. 2012;35(2):e137-e143. doi: 10.3928/01477447-20120123-09. [PubMed: 22310396].
16. Dilogo IH, Djaja YP. Hemi or Total Hip Arthroplasty in Hip Fractures: What is the Contemporary Recommendations? Real Scenario and How I Select My Patients. In: Tanavalee A, Mow
CS, Abbas AA, Azores GMS, Budhiparama NC, Lo NN, Editors. Comprehensive Hip and Knee Textbook. 1st ed. Bangkok, Thailand: Holistic Publishing; 2013. p. 268-83.
17. Fan L, Dang X, Wang K. Comparison between bipolar hemiarthroplasty and total hip arthroplasty for unstable intertrochanteric fractures in elderly osteoporotic patients. PLoS One. 2012;7(6):e39531. doi: 10.1371/journal.pone.0039531. [PubMed: 22745778]. [PubMed Central: PMC3382155].
18. Burgers PT, Van Geene AR, Van den Bekerom MP, Van Lieshout EM, Blom B, Aleem IS, et al. Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures in the healthy elderly: A meta-analysis and systematic review of randomized trials. Int Orthop. 2012;36(8):1549-60. doi: 10.1007/s00264-012-1569-7. [PubMed: 22623062]. [PubMed Central: PMC3535035].
19. Daabiss M. American society of anaesthesiologists physical status classification. Indian J Anaesth. 2011;55(2):111-5. doi:
10.4103/0019-5049.79879. [PubMed: 21712864]. [PubMed Central: PMC3106380].
20. Ossendorf C, Scheyerer MJ, Wanner GA, Simmen HP, Werner CM. Treatment of femoral neck fractures in elderly patients over 60 years of age-which is the ideal modality of primary joint replacement? Patient Saf Surg. 2010;4(1):16. doi: 10.1186/1754-9493-4-16. [PubMed: 20961437]. [PubMed Central: PMC2972258].
21. Yang B, Lin X, Yin XM, Wen XZ. Bipolar versus unipolar hemiarthroplasty for displaced femoral neck fractures in the elder patient: A systematic review and meta-analysis of randomized trials. Eur J Orthop Surg Traumatol. 2015;25(3): 425-33. doi: 10.1007/s00590-014-1565-2. [PubMed: 25476243].
22. Jia Z, Ding F, Wu Y, Li W, Li H, Wang D, et al. Unipolar versus bipolar hemiarthroplasty for displaced femoral neck fractures: A systematic review and meta-analysis of
randomized controlled trials. J Orthop Surg Res. 2015;10:8. doi: 10.1186/s13018-015-0165-0. [PubMed: 25616914]. [PubMed Central: PMC4334611].
23. Robertson GA, Wood AM. Hip hemi-arthroplasty for neck of femur fracture: What is the current evidence? World J Orthop. 2018;9(11):235-44. doi: 10.5312/wjo.v9.i11.235. [PubMed: 30479970]. [PubMed Central: PMC6242732].
24. Veldman HD, Heyligers IC, Grimm B, Boymans TA. Cemented versus cementless hemiarthroplasty for a displaced fracture of the femoral neck: A systematic review and meta-analysis of current generation hip stems. Bone Joint J. 2017;99-B(4):421-31.
doi: 10.1302/0301-620X.99B4.BJJ-2016-0758.R1. [PubMed: 28385929].
25. Luo X, He S, Li Z, Huang D. Systematic review of cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures in older patients. Arch Orthop Trauma Surg. 2012;132(4):455-63. doi: 10.1007/s00402-011-1436-9. [PubMed: 22160512].
26. Grosso MG, Danoff JR, Padgett DE, Iorio R, Macaulay WB. The cemented unipolar prosthesis for the management of displaced femoral neck fractures in the dependent osteopenic
elderly. J Arthroplasty. 2016;31(5):1040-6. doi: 10.1016/j.arth.2015.11.029. [PubMed: 26742902].
27. National Institute for Health and Care Excellence. Evidence review and recommendations–Displaced intracapsular hip fracture. In: National Institute for Health and Care Excellence, Editor. Addendum to Clinical Guideline 124, Hip fracture: Management. London, UK: National Institute for Health and Care Excellence; 2017.
28. van der Sijp MPL, van Delft D, Krijnen P, Niggebrugge AHP, Schipper IB. Surgical approaches and hemiarthroplasty outcomes for femoral neck fractures: A meta-analysis. J Arthroplasty. 2018;33(5):1617-27. doi: 10.1016/j.arth.2017.12.029. [PubMed: 29398259].
29. Kunkel ST, Sabatino MJ, Kang R, Jevsevar DS, Moschetti WE. A systematic review and meta-analysis of the direct anterior approach for hemiarthroplasty for femoral neck fracture. Eur J Orthop Surg Traumatol. 2018;28(2):217-32 doi: 10.1007/s00590-017-2033-6. [PubMed: 28852880].
2. Hayat Z, Varacallo M. Surgical management of femoral neck fractures. StatPearls [Internet] Treasure Island (FL): StatPearls Publishing 2020. [PubMed: 30855824].
3. Smith-Petersen MN, CAVE EF, VANGORDER GW. Intracapsular fractures of the neck of the femur: treatment by internal fixation. Arch Surg. 1931;23(5):715-59. doi: 10.1001/archsurg.1931.01160110002001
4. Bhandari M, Devereaux PJ, Swiontkowski MF, Tornetta P 3rd, Obremskey W, Koval KJ, et al. Internal fixation compared with arthroplasty for displaced fractures of the femoral neck. A meta-analysis. J Bone Joint Surg Am. 2003;85(9):1673-81. doi: 10.2106/00004623-200309000-00004. [PubMed: 12954824].
5. Bhandari M, Devereaux PJ, Tornetta P 3rd, Swiontkowski MF, Berry DJ, Haidukewych G, et al. Operative management of displaced femoral neck fractures in elderly patients. An international survey. J Bone Joint Surg Am. 2005;87(9):2122-30. doi: 10.2106/JBJS.E.00535. [PubMed: 16140828].
6. Florschutz AV, Langford JR, Haidukewych GJ, Koval KJ. Femoral neck fractures: Current management. J Orthop Trauma. 2015;29(3):121-9. doi: 1097/BOT.0000000000000291. [PubMed: 25635363].
7. Zielinski SM, Meeuwis MA, Heetveld MJ, Verhofstad MH, Roukema GR, Patka P, et al. Adherence to a femoral neck fracture treatment guideline. Int Orthop. 2013;37(7):1327-34. doi: 10.1007/s00264-013-1888-3. [PubMed: 23595233]. [PubMed Central: PMC3685653].
8. Mathews V, Cabanela ME. Femoral neck nonunion treatment. Clin Orthop Relat Res. 2004;(419):57-64. doi: 10.1097/00003086-200402000-00010. [PubMed: 15021132].
9. Raaymakers EL, Marti RK. Nonunion of the femoral neck: Possibilities and limitations of the various treatment modalities. Indian J Orthop. 2008;42(1):13-21. doi: 10.4103/0019-
5413.38575. [PubMed: 19823649]. [PubMed Central:
PMC2759582].
10. Bhandari M, Tornetta P, III, Hanson B, Swiontkowski MF. Optimal internal fixation for femoral neck fractures: Multiple screws or sliding hip screws? J Orthop Trauma. 2009;23(6): 403-7. doi: 10.1097/BOT.0b013e318176191f. [PubMed: 19550225].
11. Shen M, Wang C, Chen H, Rui YF, Zhao S. An update on the Pauwels classification. J Orthop Surg Res. 2016;11(1):161. doi: 10.1186/s13018-016-0498-3. [PubMed: 27955672]. [PubMed Central: PMC5154085].
12. Bray TJ. Femoral neck fracture fixation. Clinical decision making. Clin Orthop Relat Res. 1997;(339):20-31. doi: 10.1097/00003086-199706000-00004. [PubMed: 9186197].
13. Keating JF, Grant A, Masson M, Scott NW, Forbes JF. Randomized comparison of reduction and fixation, bipolar hemiarthroplasty, and total hip arthroplasty. Treatment of displaced intracapsular hip fractures in healthy older patients. J Bone Joint Surg Am. 2006;88(2):249-60. doi: 10.2106/JBJS.E.00215. [PubMed: 16452734].
14. Leonard M, Alao U, Glynn A, Dolan M. Hip fractures: Failure of fixation and outcome of salvage arthroplasty. Eur J OrthopSurg Traumatol. 2009;19(8):553-8.
15. Liu YJ, Xu B, Li ZY, Zhang Q, Zhang YZ. Quantitative score system for the surgical decision on adult femoral neck
fractures. Orthopedics. 2012;35(2):e137-e143. doi: 10.3928/01477447-20120123-09. [PubMed: 22310396].
16. Dilogo IH, Djaja YP. Hemi or Total Hip Arthroplasty in Hip Fractures: What is the Contemporary Recommendations? Real Scenario and How I Select My Patients. In: Tanavalee A, Mow
CS, Abbas AA, Azores GMS, Budhiparama NC, Lo NN, Editors. Comprehensive Hip and Knee Textbook. 1st ed. Bangkok, Thailand: Holistic Publishing; 2013. p. 268-83.
17. Fan L, Dang X, Wang K. Comparison between bipolar hemiarthroplasty and total hip arthroplasty for unstable intertrochanteric fractures in elderly osteoporotic patients. PLoS One. 2012;7(6):e39531. doi: 10.1371/journal.pone.0039531. [PubMed: 22745778]. [PubMed Central: PMC3382155].
18. Burgers PT, Van Geene AR, Van den Bekerom MP, Van Lieshout EM, Blom B, Aleem IS, et al. Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures in the healthy elderly: A meta-analysis and systematic review of randomized trials. Int Orthop. 2012;36(8):1549-60. doi: 10.1007/s00264-012-1569-7. [PubMed: 22623062]. [PubMed Central: PMC3535035].
19. Daabiss M. American society of anaesthesiologists physical status classification. Indian J Anaesth. 2011;55(2):111-5. doi:
10.4103/0019-5049.79879. [PubMed: 21712864]. [PubMed Central: PMC3106380].
20. Ossendorf C, Scheyerer MJ, Wanner GA, Simmen HP, Werner CM. Treatment of femoral neck fractures in elderly patients over 60 years of age-which is the ideal modality of primary joint replacement? Patient Saf Surg. 2010;4(1):16. doi: 10.1186/1754-9493-4-16. [PubMed: 20961437]. [PubMed Central: PMC2972258].
21. Yang B, Lin X, Yin XM, Wen XZ. Bipolar versus unipolar hemiarthroplasty for displaced femoral neck fractures in the elder patient: A systematic review and meta-analysis of randomized trials. Eur J Orthop Surg Traumatol. 2015;25(3): 425-33. doi: 10.1007/s00590-014-1565-2. [PubMed: 25476243].
22. Jia Z, Ding F, Wu Y, Li W, Li H, Wang D, et al. Unipolar versus bipolar hemiarthroplasty for displaced femoral neck fractures: A systematic review and meta-analysis of
randomized controlled trials. J Orthop Surg Res. 2015;10:8. doi: 10.1186/s13018-015-0165-0. [PubMed: 25616914]. [PubMed Central: PMC4334611].
23. Robertson GA, Wood AM. Hip hemi-arthroplasty for neck of femur fracture: What is the current evidence? World J Orthop. 2018;9(11):235-44. doi: 10.5312/wjo.v9.i11.235. [PubMed: 30479970]. [PubMed Central: PMC6242732].
24. Veldman HD, Heyligers IC, Grimm B, Boymans TA. Cemented versus cementless hemiarthroplasty for a displaced fracture of the femoral neck: A systematic review and meta-analysis of current generation hip stems. Bone Joint J. 2017;99-B(4):421-31.
doi: 10.1302/0301-620X.99B4.BJJ-2016-0758.R1. [PubMed: 28385929].
25. Luo X, He S, Li Z, Huang D. Systematic review of cemented versus uncemented hemiarthroplasty for displaced femoral neck fractures in older patients. Arch Orthop Trauma Surg. 2012;132(4):455-63. doi: 10.1007/s00402-011-1436-9. [PubMed: 22160512].
26. Grosso MG, Danoff JR, Padgett DE, Iorio R, Macaulay WB. The cemented unipolar prosthesis for the management of displaced femoral neck fractures in the dependent osteopenic
elderly. J Arthroplasty. 2016;31(5):1040-6. doi: 10.1016/j.arth.2015.11.029. [PubMed: 26742902].
27. National Institute for Health and Care Excellence. Evidence review and recommendations–Displaced intracapsular hip fracture. In: National Institute for Health and Care Excellence, Editor. Addendum to Clinical Guideline 124, Hip fracture: Management. London, UK: National Institute for Health and Care Excellence; 2017.
28. van der Sijp MPL, van Delft D, Krijnen P, Niggebrugge AHP, Schipper IB. Surgical approaches and hemiarthroplasty outcomes for femoral neck fractures: A meta-analysis. J Arthroplasty. 2018;33(5):1617-27. doi: 10.1016/j.arth.2017.12.029. [PubMed: 29398259].
29. Kunkel ST, Sabatino MJ, Kang R, Jevsevar DS, Moschetti WE. A systematic review and meta-analysis of the direct anterior approach for hemiarthroplasty for femoral neck fracture. Eur J Orthop Surg Traumatol. 2018;28(2):217-32 doi: 10.1007/s00590-017-2033-6. [PubMed: 28852880].
| Files | ||
| Issue | Vol 5, No 2 (2019) | |
| Section | Educational Corner | |
| DOI | https://doi.org/10.18502/jost.v5i2.3753 | |
| Keywords | ||
| Femoral Neck Fracture; Internal Fixation Device; Total Hip Replacement; Hemiarthroplasty; Hip Fractures | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Moazen Jamshidi SMM, Razzaghof M, Mortazavi SJ. Decision Making in Femoral Neck Fractures: Internal Fixation versus Arthroplasty. J Orthop Spine Trauma. 2020;5(2):45-9.
