Femoral Neck Fractures: In the Bucket or on Top of the Neck?

Much controversy surrounds decision-making regarding hip arthroplasty for the treatment of acute displaced femoral neck fractures. These controversies include the decision on when prosthetic replacement is appropriate; when an attempt at open reduction and internal fixation is appropriate; which type of prosthesis to chose: monopolar, bipolar, or total hip arthroplasty; and the method of prosthetic fixation, cemented or uncemented. Generally, younger patients are treated with anatomic reduction and internal fixation, and older patients are treated with arthroplasty. Implant decisions regarding hemiarthroplasty or total hip arthroplasty, and component fixation strategy are based on activity and bone quality. Attention to detail is important to minimize complications, notably, dislocation.