Management of Displaced Femoral Neck Fractures in Elderly Patients

Rationale for Hemiarthroplasty

The American Academy of Orthopaedic Surgeons recommends hemiarthroplasty as the definitive treatment of choice for elderly patients with displaced femoral neck fractures and dementia, due to the high risk of complications associated with total hip arthroplasty 1, 2
Dynamic hip screws are not indicated for femoral head/neck fractures, and are instead used for intertrochanteric fractures, making them anatomically inappropriate for this patient 2

The American Academy of Orthopaedic Surgeons 2022 guidelines provide strong evidence for arthroplasty over fixation in displaced femoral neck fractures, with a strong recommendation for cemented femoral stems 2
The American Academy of Orthopaedic Surgeons guidelines describe a case example of an 88-year-old woman with cognitive decline and comorbidities who underwent hemiarthroplasty, similar to this patient, highlighting the importance of interdisciplinary care and early mobilization 1

The American Academy of Orthopaedic Surgeons recommends the use of cemented femoral stems, particularly important in elderly patients with likely osteoporosis, and either unipolar or bipolar hemiarthroplasty is acceptable 1, 2, 3
Administering tranexamic acid at the start of the case can reduce blood loss and transfusion needs, and providing VTE prophylaxis with fondaparinux or low molecular weight heparin is essential 1, 2, 4

Surgery within 24-48 hours of admission improves outcomes, and interdisciplinary care with an orthogeriatrics team is crucial to manage multiple comorbidities 1, 2, 5
Early mobilization reduces DVT risk and improves functional recovery, and structured geriatric rehabilitation is crucial to prevent poorer functional outcomes and increased wheelchair/bedridden status at 1 year 4

Delaying surgery beyond 48 hours increases complications and mortality, and choosing total hip arthroplasty in dementia patients with multiple comorbidities is not recommended due to high complication rates 1, 2
Using uncemented stems elevates periprosthetic fracture risk, particularly problematic in osteoporotic elderly patients, and neglecting interdisciplinary care can lead to poor management of comorbidities 3, 1