Femoral Neck Fractures in the Elderly

This chapter presents a case scenario of a 71-year-old male patient who is a community ambulator and slipped while shoveling his driveway after a snowstorm. Maintaining the patient’s original hip with a fixation device versus removing the femoral head and replacing the hip with a prosthesis has important implications for outcome and function. Multiple randomized controlled trials have compared the use of sliding hip screws (SHSs) and cancellous screws for fixation of displaced femoral neck fractures; however, many current studies lack methodological rigor. SHSs may reduce re-operations in patients with displaced fractures. Pre-existing hip pain and radiographic evidence of osteoarthritis has been an indication for total hip arthroplasty (THA). THA is generally considered a better option for patients who are active and capable of following postoperative instructions. The chapter also provides recommendations for implementing evidence-based practice in the clinical setting.