[PDF] Management of Garden-I and II Femoral Neck Fractures: Perspectives on Primary Arthroplasty | Semantic Scholar (2024)

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Primary arthroplasty has demonstrated lower revision surgery rates and equivalent postoperative mortality when compared with IF, and patients with a posterior tilt of greater than 20° have a high rate of revision surgery when treated with IF and may benefit from primary arthro Plasty.

Primary arthroplasty may be considered for Garden-I and II femoral neck fractures with posterior tilt ≥20°, especially among older patients, after a preplanned secondary analysis of data collected in the FAITH trial.

A preoperative posterior tilt of 20° and an anterior tilt greater than 10° in cases of Garden I and II femoral neck fractures increase the risk of fixation failure necessitating additional surgery, suggesting the feasibility of primary hip arthroplasty.

No differences in patient-reported outcomes were found between the groups although IF required a higher rate of reoperations, and further randomized trials are needed to establish the optimal treatment of undisplaced FNF in the elderly.

In comparison with internal fixation, arthroplasty for the treatment of a displaced femoral neck fracture significantly reduces the risk of revision surgery, at the cost of greater infection rates, blood loss, and operative time and possibly an increase in early mortality rates.

Internal fixation with cannulated screws for UFNF in the elderly is a valuable option, although it has substantial reoperation and mortality rates.

A meta-analysis suggests that hemiarthroplasty might be a better treatment choice than internal fixation in treating elderly patients with an undisplaced femoral neck fracture.

This study elucidated further the complication rate of nondisplaced femoral neck fractures treated with internal screw fixation and believes that hemiarthroplasty is a reasonable treatment option in select patients.

One in 10 patients ≥60 years of age treated with internal fixation for a nondisplaced femoral neck fracture underwent conversion to arthroplasty within 5 years, and more than one-half of the conversions occurred within the first year.

Hemiarthroplasty led to improved mobility and fewer major reoperations, suggesting that certain elderly patients with a nondisplaced femoral neck fracture may benefit from being treated with a latest-generation hemiarthoplasty rather than screw fixation.

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