Management Of Femoral Neck Fractures In Young / Middle Aged Adults
Femoral neck fractures account for nearly half of all hip fractures with the vast majority occurring in elderly patients after simple falls. Currently there is 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 / middle aged patients (40 to 65 years) preservation of the natural hip anatomy and mechanics is a priority in management because of their high functional demands especially in Indian population. 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 relatively 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 middle aged patients with femoral neck fractures and the current methodology and evidence behind the surgical management of these injuries.
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