JAAOS - 2026-09-01 - Journal Article; Review
Fix or Replace: Evidence for Treatment Options in the Management of Femoral Neck Fractures.
Nauth A, Schemitsch G, Schmidt A, Schemitsch E
Topics
Key Takeaway
Acute arthroplasty use for femoral neck fractures is increasing, with cemented hemiarthroplasty demonstrating reduced revision rates and superior functional outcomes compared to uncemented constructs in elderly patients with displaced fractures.
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Summary
This narrative review evaluates indications, technical considerations, and outcomes for internal fixation versus arthroplasty in femoral neck fractures. It synthesizes evidence on patient and injury factors—including Garden and Pauwels classification, posterior tilt, and bone quality—that drive treatment selection. The review documents a trend toward acute arthroplasty, supported by data showing cemented hemiarthroplasty reduces revision rates versus uncemented constructs and that posterior tilt >20° predicts 3–5-fold increased fixation failure risk.
Key Limitation
As a narrative review without systematic search methodology or meta-analytic pooling, conclusions are susceptible to author selection bias and cannot generate new effect size estimates.
Original Abstract
Femoral neck fractures are highly morbid injuries in elderly populations and can be challenging to treat. Surgical management can consist of internal fixation or arthroplasty after careful consideration of injury and patient factors. There has been a trend toward increased usage of acute arthroplasty in the management of femoral neck fractures. The present review aims to evaluate treatment indications, technical considerations, and treatment outcomes in the management of hip trauma with both internal fixation and arthroplasty.