Skip to main content
SpringerLink
Log in

Femoral Neck Fractures: Non-Displaced, Displaced, Non-Union

  • Living reference work entry
  • First Online:
Hip Arthroscopy and Hip Joint Preservation Surgery

  • 40 Accesses

Abstract

Femoral neck fractures can be devastating orthopedic injuries. These fractures occur in a bimodal distribution; most fractures occur in elderly patients from low energy falls, while young patients often sustain these injuries as a result of high energy trauma. Fractures are classified based on degree of displacement and orientation of the fracture plane. Treatment for young patients with femoral neck fracture involves anatomic reduction and fixation. In elderly patients, nondisplaced fractures are treated with in situ internal fixation. Displaced fractures are better managed with arthroplasty. Complications such as avascular necrosis, malunion, and nonunion are significant and often lead to revision surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Similar content being viewed by others

References

  1. Bhandari M, Einhorn TA, Guy-att G, Schemitsch EH, Zura RD, Sprague S, et al. Total hip arthroplasty or hemiarthroplasty for hip fracture. N Engl J Med. 2019;23(23):2199–208.

    Google Scholar 

  2. Miyamoto R, Kaplan K, Levine BR, Egol KA, Zuckerman JD. Surgical management of hip fractures: an evidence-based review of the literature. I: femoral neck fractures. J Am Acad Orthop Surg. 2008;16(11):665–73.

    Article  PubMed  Google Scholar 

  3. Gullberg B, Johnell O, Kanis JA. World-wide projections for hip fracture. Osteoporos Int. 1997.

    Google Scholar 

  4. Robinson CM, Court-Brown CM, McQueen MM, Christie J. Hip fractures in adults younger than 50 years of age: epidemiology and results. Clin Orthop Relat Res. 1995;312:238–46.

    Google Scholar 

  5. Damany DS, Parker MJ, Chojnowski A. Complications after intracapsular hip fractures in young adults a meta-analysis of 18 published studies involving 564 fractures. Injury. 2005;36:1310141.

    Google Scholar 

  6. Johnson JP, Borenstein TR, Waryasz GR, Klinge SA, McClure PK, Chambers AB, et al. Vertically oriented femoral neck fractures: a biomechanical comparison of 3 fixation constructs. J Orthop Trauma. 2017;31(7):363–8.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Florschutz AV, Langford JR, Haidukewych GJ, Koval KJ. Femoral neck fractures: current management. J Orthop Trauma. 2015;29(3):121–9.

    Article  PubMed  Google Scholar 

  8. Tornetta P, Kain MSH, Creevy WR. Diagnosis of femoral neck fractures in patients with a femoral shaft fracture: improvement with a standard protocol. J Bone Joint Surg Ser A. 2007;89(1):39–43.

    Article  Google Scholar 

  9. Hakkarinen DK, Banh KV, Hendey GW. Magnetic resonance imaging identifies occult hip fractures missed by 64-slice computed tomography. J Emerg Med. 2012;43(2):303–7.

    Article  PubMed  Google Scholar 

  10. Garden RS. Low-angle fixation in fractures of the femoral neck. J Bone Joint Surg Br. 1961;43-B(4):647–63.

    Article  Google Scholar 

  11. Pauwels F. Der schenkelhalsbruch ein mechanisches problem: Grund-lagen des Haeilungsvorganges Prognose und kausale Therapie. Stuttgart: Ferdinand Enke Verlag; 1935.

    Google Scholar 

  12. Bartoníček J. Pauwels’ classification of femoral neck fractures: correct interpretation of the original. J Orthop Trauma. 2001;15(5):358–60.

    Article  PubMed  Google Scholar 

  13. Aminian A, Gao F, Fedoriw WW, Zhang LQ, Kalainov DM, Merk BR. Vertically oriented femoral neck fractures: mechanical analysis of four fixation techniques. J Orthop Trauma. 2007;21(8):544–8.

    Article  PubMed  Google Scholar 

  14. Chlebeck JD, Birch CE, Blankstein M, Kristiansen T, Bartlett CS, Schottel PC. Nonoperative geriatric hip fracture treatment is associated with increased mortality: a matched cohort study. In: J Orthop Trauma Lippincott Williams and Wilkins; 2019. p. 346–50.

    Google Scholar 

  15. Xu DF, Bi FG, Ma CY, Wen ZF, Cai XZ. A systematic review of undisplaced femoral neck fracture treatments for patients over 65 years of age, with a focus on union rates and avascular necrosis. J Orthop Surg Res. 2017;12(1):1–12.

    Article  Google Scholar 

  16. Tanaka J, Seki N, Tokimura F, Hayashi Y. Conservative treatment of Garden stage I femoral neck fracture in elderly patients. Arch Orthop Trauma Surg. 2002;122(1):24–8.

    Article  CAS  PubMed  Google Scholar 

  17. Fracture fixation in the operative management of hip fractures (FAITH): an international, multicentre, randomised controlled trial. Lancet. 2017;389:1519–27.

    Google Scholar 

  18. Haidukewych GJ, Rothwell WS, Jacofsky DJ, Torchia ME, Berry DJ. Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years. J Bone Joint Surg Ser A. 2004;86(8):1711–6.

    Article  Google Scholar 

  19. Augat P, Bliven E, Hackl S. Biomechanics of femoral neck fractures and implications for fixation. J Orthop Trauma. 2019;33:S27–32.

    Article  PubMed  Google Scholar 

  20. Hoffmann JC, Kellam J, Kumaravel M, Clark K, Chip Routt ML, Gary JL. Is the cranial and posterior screw of the “inverted triangle” configuration for femoral neck fractures safe? J Orthop Trauma. 2019;33(7):331–4.

    Article  PubMed  Google Scholar 

  21. Shin KH, Hong SH, Han SB. Posterior fully threaded positioning screw prevents femoral neck collapse in Garden I or II femoral neck fractures. Injury. 2020;4(17):1–7.

    Google Scholar 

  22. Aibinder WR, Yuan BJ, Cross WW III, Parry JA. Sequential fluoroscopic rollover images reliably identify “in-out-in” posterosuperior screws during percutaneous fixation of femoral neck fractures. Eur J Orthop Surg Traumatol. 2020;(3). Epub ahead of print.

    Google Scholar 

  23. Hawks MA, Kim H, Strauss JE, Oliphant BW, Golden RD, Hsieh AH, et al. Does a trochanteric lag screw improve fixation of vertically oriented femoral neck fractures? A biomechanical analysis in cadaveric bone. Clin Biomech. 2013;28(8):886–91.

    Article  Google Scholar 

  24. Baumgaertner MR, Curtin SL, Lindskog D, Keggi J. The value of tip apex distance. J Bone Joint Surg. 1995;1058–64.

    Google Scholar 

  25. Hoshino CM, Christian MW, O’toole RV, Manson TT. Fixation of displaced femoral neck fractures in young adults: fixed-angle devices or Pauwel screws? Injury. 2016;47:1676–84.

    Article  CAS  PubMed  Google Scholar 

  26. Olsen M, Goshulak P, Crookshank MC, Moktar J, Brazda IJ, Schemitsch EH, et al. Biomechanical testing of a 3-hole versus a 4-hole sliding hip screw in the presence of a retrograde intramedullary nail for ipsilateral intertrochanteric and femur shaft fractures. J Orthop Trauma. 2018;32(8):419–24.

    Article  PubMed  Google Scholar 

  27. McLoughlin SW, Wheeler DL, Rider J, Bolhofner B. Biomechanical evaluation of the dynamic hip screw with two- and four-hole side plates. J Orthop Trauma. 2000;14(5):318–23.

    Article  CAS  PubMed  Google Scholar 

  28. Han S, Song H, Kim R, Kang S. Clinical results of treatment of garden type 1 and 2 femoral neck fractures in patients over 70-year old. Eur J Trauma Emerg Surg. 2016;42:191–6.

    Article  CAS  PubMed  Google Scholar 

  29. Jain N, Brock JL, Malik AT, Phillips FM, Khan SN. Prediction of complications, readmission, and revision surgery based on duration of preoperative opioid use. J Bone Joint Surg. 2019;101(5):384–91.

    Article  PubMed  Google Scholar 

  30. Richards JT, Overmann AL, O’Hara NN, D’Alleyrand J-C, Slobogean GP. Internal fixation versus arthroplasty for the treatment of non-displaced femoral neck fractures in the elderly: a systematic review and meta-analysis. J Orthop Trauma. 2019;34(1):42–8.

    Article  Google Scholar 

  31. Sprague S, Schemitsch EH, Swiontkowski M, Della Rocca GJ, Jeray KJ, Liew S, et al. Factors associated with revision surgery after internal fixation of hip fractures. J Orthop Trauma. Lippincott Williams and Wilkins. 2018;223–30.

    Google Scholar 

  32. Felton J, Slobogean GP, Jackson SS, Della Rocca GJ, Liew S, Haverlag R, et al. Femoral neck shortening after hip fracture fixation is associated with inferior hip function: results from the FAITH trial. J Orthop Trauma. 2019;33(10):487–96.

    Article  PubMed  Google Scholar 

  33. Medda S, Snoap T, Carroll EA. Treatment of young femoral neck fractures. J Orthop Trauma. 2019;33(1):S1–6.

    Article  PubMed  Google Scholar 

  34. Kilian M, Csörgő P, Šajter M, Šimkovic P, Vajcziková S, Zamborský R. Locking plate fixation with multiple telescoping sliding screws for femoral neck fractures. Ortop Traumatol Rehabil. 2018;20(6):493–8.

    Article  PubMed  Google Scholar 

  35. Cserhsti P, Kazlir G, Manninger J, Fekete K, Frenyd S. Non-operative or operative treatment for undisplaced femoral neck fractures: a comparative study of 122 non-operative and 125 operatively treated cases. Injury. 1996;27.

    Google Scholar 

  36. Xu J-L, Liang Z-R, Xiong B-L, Zou Q-Z, Lin T-Y, Yang P, et al. Risk factors associated with osteonecrosis of femoral head after internal fixation of femoral neck fracture: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2019;20(632):1–11.

    PubMed  PubMed Central  Google Scholar 

  37. Molnar RB, Routt ML. Open reduction of intracapsular hip fractures using a modified Smith-Petersen surgical exposure. J Orthop Trauma. 2007;21(7):490–4.

    Article  PubMed  Google Scholar 

  38. Lichstein PM, Kleimeyer JP, Githens M, Vorhies JS, Gardner MJ, Bellino M, et al. Does the Watson-Jones or modified Smith-Petersen approach provide superior exposure for femoral neck fracture fixation? Clin Orthop Relat Res. 2018;476(7):1468–76.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Maruenda JI, Barrios C, Gomar-Sancho F. Intracapsular hip pressure after femoral neck fracture. Clin Orthop Relat Res. 1997 Jul;340:172–80.

    Article  Google Scholar 

  40. Jain R, Koo M, Kreder HJ, Schemitsch EH, Davey JR, Mahomed NN. Comparison of early and delayed fixation of subcapital hip fractures in patients sixty years of age or less. J Bone Joint Surg Ser A. 2002;84(9):1605–12.

    Article  Google Scholar 

  41. Kregor PJ. The effect of femoral neck fractures on femoral head blood flow. Orthopedics. 1996;19(12):1031–6. quiz 1037–8.

    Article  CAS  PubMed  Google Scholar 

  42. Della Rocca GJ. Gaps and opportunities in the management of the young femoral neck fracture. Injury. 2015;46:515–8.

    Article  PubMed  Google Scholar 

  43. Gardner S, Weaver MJ, Jerabek S, Rodriguez E, Vrahas M, Harris M. Predictors of early failure in young patients with displaced femoral neck fractures. J Orthop. 2015;12:75–80.

    Article  PubMed  Google Scholar 

  44. Papakostidis C, Panagiotopoulos A, Piccioli A, Giannoudis PV. Timing of internal fixation of femoral neck fractures. A systematic review and meta-analysis of the final outcome. Injury. 2015;46:459–66.

    Article  PubMed  Google Scholar 

  45. Razik F, Alexopoulos A-S, El-Osta B, Connolly MJ, Brown A, Hassan S, et al. Time to internal fixation of femoral neck fractures in patients under sixty years-does this matter in the development of osteonecrosis of femoral head? Int Orthop. 2012;36:2127–32.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Gerber C, Strehle J, Ganz R. The treatment of fractures of the femoral neck. Clin Orthop Relat Res. 1993;77–86.

    Google Scholar 

  47. Swiontkowski MF, Winquist RA, Hansen ST. Fractures of the femoral neck in patients between the ages of twelve and forty-nine years. J Bone Joint Surg Ser A. 1984;66(6):837–46.

    Article  CAS  Google Scholar 

  48. Samuel AM, Russo GS, Lukasiewicz AM, Webb ML, Bohl DD, Basques BA, et al. Surgical treatment of femoral neck fractures after 24 hours in patients between the ages of 18 and 49 is associated with poor inpatient outcomes: an analysis of 1361 patients in the National Trauma Data Bank. J Orthop Trauma. 2016;30(2):89–94.

    Article  PubMed  Google Scholar 

  49. Upadhyay A, Jain P, Mishra P, Maini L, Gautum VK, Dhaon BK. Delayed internal fixation of fractures of the neck of the femur in young adults. J Bone Joint Surg Ser B. 2004;86:1035–40.

    Article  CAS  Google Scholar 

  50. Mitchell SM, Chung AS, Walker JB, Hustedt JW, Russell GV, Jones CB. Delay in hip fracture surgery prolongs postoperative hospital length of stay but does not adversely affect outcomes at 30 days. J Orthop Trauma. 2018;32(12):629–33.

    Article  PubMed  Google Scholar 

  51. Lewis DP, Waever D, Thorninger R, Donnelly WJ. Hemiarthroplasty vs total hip arthroplasty for the management of displaced neck of femur fractures: a systematic review and meta-analysis. J Arthroplast. 2019;34:1837–43.

    Article  Google Scholar 

  52. Tan KG, Whitehouse SL, Crawford RW. On-table and short-term mortality: a single-institution experience with cementing all hip arthroplasties for neck of femur fractures. J Arthroplast. 2020;35(4):1095–100.

    Article  Google Scholar 

  53. Parker MI, Pryor G, Gurusamy K. Cemented versus uncemented hemiarthroplasty for intracapsular hip fractures. J Bone Joint Surg Br. 2010;92-B(1):116–22.

    Article  Google Scholar 

  54. Veldman HD, Heyligers IC, Grimm B, Boymans TAEJ. Cemented versus cementless hemiarthroplasty for a displaced fracture of the femoral neck. Bone Joint J. 2017;99-B(4):421–31.

    Article  CAS  PubMed  Google Scholar 

  55. Van Den Bekerom MPJ, Hilverdink EF, Sierevelt IN, Reuling EMBP, Schnater JM, Bonke H, et al. A comparison of hemiarthroplasty with total hip replacement for displaced intracapsular fracture of the femoral neck: a randomised controlled multicentre trial in patients aged 70 years and over. J Bone Joint Surg Ser B. 2010;92(10):1422–8.

    Article  Google Scholar 

  56. von Roth P, Abdel MP, Harmsen WS, Berry DJ. Cemented bipolar hemiarthroplasty provides definitive treatment for femoral neck fractures at 20 years and beyond. Clin Orthop Relat Res. 2015;473(11):3595–9.

    Article  Google Scholar 

  57. Filippo M, Driessen A, Colarossi G, Quack V, Tingart M, Eschweiler J. Bipolar versus monopolar hemiarthroplasty for displaced femur neck fractures: a meta-analysis study. Eur J Orthop Surg Traumatol. 2019;30(3).

    Google Scholar 

  58. Iamthanaporn K, Chareancholvanich K, Pornrattanamaneewong C. Reasons for revision of failed hemiarthroplasty: are there any differences between unipolar and bipolar? Eur J Orthop Surg Traumatol. 2018;28(3):1117–23.

    Article  PubMed  Google Scholar 

  59. 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.

    Article  PubMed  Google Scholar 

  60. Tol MCJM, Van Den Bekerom MPJ, Sierevelt IN, Hilverdink EF, Raaymakers ELFB, Goslings JC. Hemiarthroplasty or total hip arthroplasty for the treatment of a displaced intracapsular fracture in active elderly patients 12-year follow-up of randomised trial. Bone Joint J. 2017;99-B(2):250–4.

    Article  CAS  PubMed  Google Scholar 

  61. Su EP, Su SL. Femoral neck fractures: a changing paradigm. Bone Joint J. 2014;96B(11):43–7.

    Article  Google Scholar 

  62. Ravi B, Pincus D, Khan H, Wasserstein D, Jenkinson R, Kreder HJ. Comparing complications and costs of total hip arthroplasty and hemiarthroplasty for femoral neck fractures: a propensity score-matched, population-based study. J Bone Jt Surg. 2019;101(7):572–9.

    Article  Google Scholar 

  63. Investigators TH. Total hip arthroplasty or hemiarthroplasty for hip fracture. N Engl J Med. 2019;1–10.

    Google Scholar 

  64. Sassoon A, Apuzzo MD’, Sems S, Cass J, Mabry T. Total hip arthroplasty for femoral neck fracture comparing in-hospital mortality, complications, and disposition to an elective patient population. J Arthroplast. 2013;28:1659–62.

    Article  Google Scholar 

  65. Gjertsen JE, Lie SA, Fevang JM, Havelin LI, Engesaeter LB, Vinje T, et al. Total hip replacement after femoral neck fractures in elderly patients: results of 8,577 fractures reported to the Norwegian arthroplasty register. Acta Orthop. 2007;78(4):491–7.

    Article  PubMed  Google Scholar 

  66. Duckworth AD, Bennet SJ, Aderinto J, Keating JF. Fixation of intracapsular fractures of the femoral neck in young patients: risk factors for failure. J Bone Joint Surg Ser B. 2011;93 B(6):811–6.

    Article  Google Scholar 

  67. Slobogean GP, Sprague SA, Scott T, Bhandari M. Complications following young femoral neck fractures. Injury. 2015;46:484–91.

    Article  CAS  PubMed  Google Scholar 

  68. Angelini M, McKee MD, Waddell JP, Haidukewych G, Schemitsch EH. Salvage of failed hip fracture fixation. J Orthop Trauma. 2009;471–8.

    Google Scholar 

  69. Post ZD, Orozco F, Diaz-Ledezma C, Hozack WJ, Ong A. Direct anterior approach for total hip arthroplasty. J Am Acad Orthop Surg. 2014;22(9):595–603.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA

    E. Bailey Terhune & Joel C. Williams

Authors
  1. E. Bailey Terhune
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joel C. Williams
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA

    Shane J. Nho

  2. Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI, USA

    Bedi Asheesh

  3. Department of Orthopedic Surgery, Case Western Reserve University, Cleveland, OH, USA

    Michael J. Salata

  4. Department of Orthopedic Surgery, Duke Medical Center, Durham, NC, USA

    Richard C. Mather III

  5. Department of Orthopedic Surgery, Weill Medical College of Cornell Univers, New York, NY, USA

    Bryan T. Kelly

Section Editor information

  1. Premier Hip Arthroscopy, Marina del Rey, CA, USA

    Dean K. Matsuda

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Science+Business Media, LLC, part of Springer Nature

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Terhune, E.B., Williams, J.C. (2021). Femoral Neck Fractures: Non-Displaced, Displaced, Non-Union. In: Nho, S.J., Asheesh, B., Salata, M.J., Mather III, R.C., Kelly, B.T. (eds) Hip Arthroscopy and Hip Joint Preservation Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7321-3_183-1

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-7321-3_183-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-7321-3

  • Online ISBN: 978-1-4614-7321-3

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation