Evolution of Technology

Femoral Neck Open Reduction And Internal Fixation

Historically they have treated with independent screws placed into the femoral neck, but this provides no compression to encourage bone healing. There have also been many plating systems, but these often require a large dissection that can put the blood supply to the femoral head at risk and may hasten osteonecrosis (bone death due to a lack of blood supply).

Soon there were specific plates like the Dynamic Hip Screw (DHS) that were used to provide compression across the fracture site to encourage bone healing. However, these had poor rotational control because the fragment in the hip joint could still rotate independently as the screw was advanced.

Evolution of Procedure

Femoral Neck Fracture Surgery

The anatomy of the femora neck makes it very difficult to treat with a plate and screws. There exists a large amount of force that is transmitted through the femoral neck with ambulation, and many of these fractures may also be able to rotate, which would prevent healing in the proper alignment.

For these reasons, stability is important to help these fractures heal. Joint replacement remains an option for older or less active patients, because it does not depend on fracture healing but is not an option for the younger population.

Evolution of Diagnosis

Femoral Neck Fracture

Femoral neck fractures are a serious injury that either happen in elderly patients with poor bone quality or in younger patients who sustain a high energy trauma such as a serious motor vehicle accident. These fractures need to be treated with surgery, but even then then there are a high risk of possible complications like non-union (lack of healing of the fracture), malunion (healing in an inappropriate position), and osteonecrosis (lack of blood flow causing bone death) to the femoral head.

There exist two main options to treat these fractures: joint replacement or plate fixation with screws, also known as open reduction and internal fixation (ORIF). In the young, active patient ORIF is often the treatment of choice.