From the Research
Non-displaced femoral neck fractures should be treated with internal fixation using cannulated screws, as this approach results in less surgical insult, lower in-hospital mortality, and comparable functional outcomes to hemiarthroplasty, as demonstrated in the most recent and highest quality study 1.
Evaluation and Treatment
Evaluation of non-displaced femoral neck fractures typically involves a thorough physical examination and imaging studies, primarily X-rays, with CT scans or MRI sometimes needed for subtle fractures. Treatment generally consists of surgical fixation with cannulated screws or a sliding hip screw to stabilize the fracture while preserving the native femoral head. Surgery is usually performed within 24-48 hours of injury to reduce complications.
- Key considerations in treatment include:
- Surgical approach: Internal fixation with cannulated screws is preferred due to its benefits in reducing surgical insult and in-hospital mortality 1.
- Patient selection: Extremely frail patients or those with limited mobility may be considered for non-operative management with protected weight-bearing, though this carries higher risks of displacement and non-union.
- Post-operative care: Patients require physical therapy, pain management, and thromboprophylaxis to prevent complications and promote recovery.
Mortality Rate
The overall mortality rate for hip fractures, including non-displaced femoral neck fractures, is approximately 20-30% within the first year after injury, with higher rates in elderly patients and those with significant comorbidities 1. This high mortality is attributed to complications such as pneumonia, thromboembolism, and cardiac events rather than the fracture itself.
- Factors influencing mortality include:
- Age: Elderly patients have higher mortality rates due to increased comorbidities and reduced physiological reserve.
- Comorbidities: Presence of significant comorbidities increases the risk of mortality and complications.
- Early mobilization and comprehensive geriatric care can help improve outcomes and reduce mortality risk, as supported by the findings of 1.
Quality of Life
Quality of life after non-displaced femoral neck fractures can be significantly impacted by the treatment approach and post-operative care.
- Key factors influencing quality of life include:
- Functional outcomes: The ability to return to pre-fracture walking ability and maintain independence is crucial for quality of life.
- Pain management: Effective pain management is essential to prevent chronic pain and promote recovery.
- Rehabilitation: Comprehensive rehabilitation programs, including physical therapy, can help improve functional outcomes and quality of life, as demonstrated in the study by 1.