Therapy
As the previous section has shown, surgical treatment of a femoral neck fracture is not always necessary. The necessity is derived from the described classification systems according to Garden and Pauwels, but is always an individual case decision, in which factors such as age and complaints of the patient are also taken into account. Conservative treatment, i.e. treatment without surgery, is recommended for stable or wedged fractures (Pauwels I and Garden I to II), as already indicated in the recommendations for the individual classification systems.
Conservative treatment consists of immobilizing the affected limb so that the fractured bone parts underneath can grow back together again. If the immobilized bone ends do shift in the course of conservative treatment, surgery should be sought immediately. In order to minimize the physical consequences of immobilization, especially in older people, the affected limb must be mobilized under professional guidance as soon as possible.
If an unstable fracture is treated conservatively due to the inoperability of the patient, although surgical treatment would be indicated, care must be taken to ensure that the patient is immobilized for a sufficiently long period of time and that effective prophylaxis against concomitant diseases such as thromboses or embolisms is taken. The operation of a femoral neck fracture is recommended in unstable fracture conditions and is characterized by better stability and shorter immobilization. The occurrence of complications during long conservative treatment of unstable fractures usually makes surgery necessary.
This should be performed within six hours after the injury. In younger patients, the treatment can be carried out with a dynamic hip screw (DHS) while preserving the femoral head. The injured limb is brought into the correct position before the operation and the fracture is then fixed with the hip screw via a skin incision using X-ray technology.
In patients over 65 years of age, the implantation of a hip prosthesis should be considered. In this operation, the femoral head and sometimes the acetabulum is completely replaced by artificial structures. The loading can begin relatively soon after the operation, so that complications due to long immobilization are avoided as far as possible.
