Internal fixation of femoral neck fractures with cannulated screws is a minimally invasive procedure that allows the respect of patients’ anatomy, the preservation of native hips and an early rehabilitation ( Figure 1). On the other hand, for displaced femoral neck fractures an appropriate reduction with IF is more challenging and there is sufficient agreement between surgeons that hip arthroplasty should be the surgery of choice ( 5, 6). This goal is quite simple to achieve when the fracture is not displaced, in fact internal fixation (IF) has obtained global consensus for the treatment of stages I and II. Instead, hip arthroplasty is defined as the most appropriate treatment for displaced (grade III/IV) fractures ( 4).Įspecially in younger people, surgeons are mandated to pay close attention to preservation of the femoral head, in order to restore functional anatomy as much as possible. According to AAOS (American Academy of Orthopaedics Surgeons) evidence-based guideline, stable and non-displaced fractures deserve internal fixation. Garden classified medial fractures of the femoral neck in four grades: I and II include non-displaced fractures whereas grade III and IV consist of partially and totally displaced fractures respectively. However, specific characteristics of fracture represent the primary factors that define surgical strategy. Surgical treatment changes depending on age, peculiarity and comorbidity of patients. On the other hand, younger people often develop femoral neck fractures after a quite high-energy trauma, even though a reduced bone quality can play a complementary role sometimes ( 3). In the elderly the traumatic mechanism behind hip fractures usually consists in low-energy trauma since increased risks of osteoporosis and accidental falls are directly related to old age ( 2). According to recent epidemiologic studies, the total number of femoral neck fractures will increase in the next decades: from 1.6 million cases counted through the year 2000, it will rise up to 4.5 million in 2050 ( 1). Hip fractures represent a serious disease affecting old and younger people in western countries.
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