Treatment of Subcapital Fracture of the Left Femur Neck in Elderly Patients

Initial Assessment and Surgical Decision Algorithm

• For elderly patients with displaced subcapital femoral neck fractures, the American Academy of Orthopaedic Surgeons recommends proceeding with arthroplasty rather than internal fixation, selecting between total hip arthroplasty (THA) for cognitively intact, active patients or bipolar hemiarthroplasty for frail patients, using a cemented femoral stem in both cases 1, 2, 3
• The American Academy of Orthopaedic Surgeons suggests determining fracture displacement status first, with non-displaced fractures treated with closed reduction and percutaneous cannulated screw fixation regardless of patient age 2, 4

Patient Selection for Surgical Approach (Displaced Fractures)

• The American Academy of Orthopaedic Surgeons recommends total hip arthroplasty (THA) for cognitively intact and active patients 1, 2
• The American Academy of Orthopaedic Surgeons suggests bipolar hemiarthroplasty for frail patients with limited functional demands 2, 3, 5

Critical Technical Requirements

• The American Academy of Orthopaedic Surgeons strongly recommends using cemented femoral stems in all elderly hip fracture patients 1, 5
• The American Academy of Orthopaedic Surgeons notes that no single surgical approach (anterior, lateral, posterior) demonstrates superiority in general populations 1, 5

Perioperative Management Protocol

• The American Academy of Orthopaedic Surgeons recommends involving an orthogeriatric team or hospitalist for medical optimization before surgery 1
• The American Academy of Orthopaedic Surgeons suggests administering prophylactic antibiotics before incision 5

Thromboembolism Prophylaxis

• The American Academy of Orthopaedic Surgeons strongly recommends administering VTE prophylaxis for a minimum of 1 month postoperatively 1, 6

Postoperative Care and Mobilization

• The American Academy of Orthopaedic Surgeons recommends beginning weight-bearing as tolerated immediately postoperatively with physical therapy starting on postoperative day 1 1, 5

Secondary Fracture Prevention

• The American Academy of Orthopaedic Surgeons emphasizes that every patient ≥50 years with a fragility fracture requires systematic osteoporosis evaluation 2, 3, 4
• The American Academy of Orthopaedic Surgeons recommends implementing a Fracture Liaison Service (FLS) if available 4
• The American Academy of Orthopaedic Surgeons suggests initiating drugs demonstrated to reduce vertebral, non-vertebral, and hip fracture risk (bisphosphonates, denosumab, or anabolic agents depending on fracture risk profile) 2, 3, 4