Orthopaedic treatment of displaced femoral neck fractures in elderly patients

Purpose and method: A review article concerning orthopaedic treatment and rehabilitation of displaced femoral neck fractures, focusing on evidence-based knowledge. Results: Properly performed randomized controlled studies comparing internal fixation and primary arthroplasty provides the best basis to decide which method should be used. During the last decade, several such studies have been published, in addition to a few earlier works. After internal fixation with pins, screws or sliding hip screw and plate, the failure rate was 21-57% and re-operations were performed in 14-53% of all the cases. In the studies using THA, the failure rate was 4-11% and the re-operation rate 2-8%. The corresponding numbers for hemi-arthroplasty were 3-23% and 0-24%. A primary arthroplasty tends to result in better function and less pain during the rehabilitation period. Conclusion: With support in evidence-based literature, an elderly patient with displaced femoral neck fracture should be treated with a primary arthroplasty. If the individual is healthy, active and mentally intact, a total hip arthroplasty should be performed, otherwise a hemi-arthroplasty. This rationale ensures fewer failures and re-operations, as well as better function and less pain during the rehabilitation.