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Strategies for improving fixation in femoral neck fractures when replacement is not the best option

Ortega, Gil MD, MPH; Aderibigbe, Kamal MD

doi: 10.1097/BCO.0000000000000323
SPECIAL FOCUS: Geriatric Orthopaedics: Part II

Femoral neck fracture in elderly individuals remains a source of high morbidity and mortality with a reported 1-year mortality rate of 20-30%. Early mobilization and restoration to preinjury activity level should be guiding factors when treating elderly patients with femoral neck fractures. Most surgeons agree that the quality of fracture reduction continues to be the most important variable when assessing the success of femoral neck fracture fixation. Although there is still insufficient evidence to recommend an optimal method of fracture fixation in femoral neck fractures, primary fixation with a sliding screw device or cannulated, cancellous screws are widely used. Hip arthroplasty is often thought of as the main treatment for displaced femoral neck fractures in patients typically over 65 yr of age. However, as our elderly population continues to have an increased lifespan, a hip replacement may not be the best option for those who are physiologically young and active despite their advanced age. This article provides an overview of the classification, treatment options, and strategies for improving femoral neck fracture fixation in elderly patients and discusses the outcomes.

Sonoran Orthopaedic Trauma Surgeons, Scottsdale, AZ

Financial Disclosure: Dr. Ortega reports a financial relationship with Smith & Nephew. Dr. Aderibigbe has no disclosures. The authors report no conflicts of interest in regard to this work.

Correspondence to Gil Ortega, MD, MPH, Orthopaedic Trauma Director, Mayo Scottsdale Orthopaedic Residency Program, Adjunct Associate Professor of Orthopaedics, Mayo Clinic, Sonoran Orthopaedic Trauma Surgeons, 3126N. Civic Center Plaza, Scottsdale, AZ 85251 Tel: +480-874-2040; fax: +480-874-2041; e-mail:

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