In a fragility fracture context, intra-capsular hip fractures are in fact through the femoral neck, as femoral head fractures are uncommon in the elderly.įemoral neck fractures are at risk of non-union with/without mechanical collapse due to insufficient fixation and/or avascular necrosis of the femoral head. During the last decades, surgical guidelines have gained ground, along with national surgical quality standards and registries with possible identification of positive and negative outliers-which is expected to further improve the surgical outcome. The stable trochanteric fractures are well treated with a sliding hip screw, while intramedullary nails seem superior for the unstable trochanteric and the sub-trochanteric fractures. The extensive literature has created partial treatment consensus: Undisplaced femoral neck fractures seem adequately treated with parallel screws/pins or a sliding hip screw, while the displaced femoral neck fractures should be given a prosthesis in elderly patients. Challenges are osteoporotic bone, bone vascularity, muscle-attachments, maintaining fracture reduction and slow fracture healing in the often-elderly population and, although reduced in recent years, still 5–20% of patients need a reoperation, mainly depending on the type of fracture and choice of surgery. Hip fractures are operated with either prosthesis or various kinds of fracture fixation devices, with the aim of immediate mobilization with full weight-bearing.
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