Surgical Management of Intracapsular Femoral Neck Fractures
Preoperative Considerations
- The American Academy of Orthopaedic Surgeons recommends bipolar hemiarthroplasty with a cemented femoral stem through a posterior approach for displaced intracapsular femoral neck fractures in elderly patients with limited mobility and osteoporosis 1, 2
- Administer tranexamic acid at the start of surgery to reduce blood loss and transfusion requirements, as recommended by the American Academy of Orthopaedic Surgeons 1, 3
- Either spinal or general anesthesia is appropriate, with no superiority of one over the other, according to the American Academy of Orthopaedic Surgeons 1, 3
- Administer multimodal analgesia incorporating a preoperative femoral nerve block for optimal pain control, as recommended by the American Academy of Orthopaedic Surgeons 1, 2, 3
Surgical Technique
- Use cemented femoral stems in all elderly patients with osteoporosis, as this is strongly recommended to improve hip function, reduce residual pain, and decrease periprosthetic fracture risk, according to the American Academy of Orthopaedic Surgeons 1, 3
- Prepare bone cement according to manufacturer specifications, as recommended by the American Academy of Orthopaedic Surgeons 1
- Insert the final femoral stem with 5-10 degrees of anteversion while the cement is still in the doughy phase 2
Postoperative Management
- Continue multimodal analgesia with regular paracetamol throughout the perioperative period, as recommended by the American Academy of Orthopaedic Surgeons 2
- Utilize interdisciplinary care programs involving orthopedics, geriatrics, physical therapy, and nursing to decrease complications and improve outcomes, according to the American Academy of Orthopaedic Surgeons 1, 3
- Arrange outpatient DEXA scan and referral to bone health clinic for osteoporosis evaluation and treatment, as recommended by the American Academy of Orthopaedic Surgeons 2
- Initiate anti-osteoporotic medication to prevent subsequent fractures, as recommended by the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis 4