SA Orthopaedic Journal
On-line version ISSN 2309-8309
Femoral neck fractures are the second most common non-vertebral fragility fracture, and their management is complicated by multiple controversies. This article aims to review the recent literature in an attempt to elucidate current concepts critical to the management of intra-capsular femoral neck fractures. The optimal timing of surgery remains controversial. A recent meta-analysis was able to show that a delay of longer than 24-72 hours resulted in a statistically significant increase in mortality. Internal fixation of undisplaced fractures remains undisputed. In terms of displaced fractures, two well-designed studies have shown significantly higher re-operation rates in patients treated with closed reduction and internal fixation. While there appears to be renewed interest in the use of bi-polar hemiarthroplasty, conflicting evidence has been published with regard to total hip replacement for hip fractures in the elderly, and it may only be indicated in selected subgroups of relatively healthy patients. The peri-operative use of tranexamic acid has recently been shown to result in a reduction in transfusion requirements. Arguably the most important recent development in the management of hip fractures is the decrease in mortality provided by intravenous bisphosphonate therapy. Apart from a reduction in subsequent fractures the therapy also appears to reduce mortality due to cardiovascular and pulmonary causes. Recent investigations into thrombopro-phylaxis have highlighted the fact there is very little data to show that potent anti-coagulation decreases the risk of fatal pulmonary emboli.
Keywords : management; hip fractures; femoral neck fractures; review.