What is the role surgery during the acute phase of hip fracture treatment?

Updated: Jan 08, 2019
  • Author: Naveenpal S Bhatti, MD; Chief Editor: Sherwin SW Ho, MD  more...
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Answer

Garden types I and II femoral neck fractures are surgically stabilized with closed reduction and internal fixation. Garden types III and IV are controversial in the type of implant used for treatment. In younger patients, closed or open reduction is recommended. In less active older patients, prosthetic replacement is recommended (see the images below). Patients with intertrochanteric hip fractures require surgical stabilization.

An example of a calcar replacement hemiarthroplast An example of a calcar replacement hemiarthroplasty. A low femoral neck fracture extending into the calcar femoralis, not amenable to internal fixation or conventional hemiarthroplasty, requiring a calcar replacement prosthesis.
A lateral x-ray film of a calcar replacement hemia A lateral x-ray film of a calcar replacement hemiarthroplasty.

In acute (or chronic) displaced femoral neck tension stress fractures, most authors recommend aggressive treatment with internal fixation with percutaneously placed cannulated screws (see the images below). Postoperative treatment is similar as above, with crutch-assisted touch-down weight-bearing ambulation for the first 6 weeks and partial weight bearing for the subsequent 6 weeks. Thereafter, a supervised physical therapy program is outlined for progressive activity, lower extremity strengthening, and full weight-bearing ambulation.

Intraoperative x-ray film (fluoroscopic view) of p Intraoperative x-ray film (fluoroscopic view) of placement of the lag screw.
Addition of a superior derotational screw to maint Addition of a superior derotational screw to maintain alignment and allow compression.
Internal fixation of the subcapital femoral neck f Internal fixation of the subcapital femoral neck fracture with a screw and short side plate with an additional derotational screw above. Final anteroposterior view.

Treatment of pediatric hip fractures requires expedient evaluation and, usually, surgical reduction and stabilization for displaced fractures. Timing of treatment is important and may play a role in the final outcome. A retrospective cohort study by Pincus et al that included 42,230 hip fracture patients reported an increase in complication risk (6.5% vs 5.8%) when patients waited more than 24 hours for surgery. [11]


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