Femoral neck fractures: Fix or replace?

The optimal management of displaced femoral neck fractures has yet to be determined. Some amount of consensus has been achieved on management of low-demand elderly patients and the younger patients with these fractures, but a large gray area exists in the management of patients who fall between these 2 groups. Incorporating physiological, rather than merely chronologic, age in treatment decisions is pivotal to appropriate management of femoral neck fractures. Given the long-term reliability of total hip arthroplasty for arthritis, there is an increasing trend toward primary total hip arthroplasty for displaced femoral neck fractures in physiologically younger patients with a reasonable life expectancy. We believe that favorable functional results can be obtained with total hip arthroplasty for physiologically younger patients with and without preexisting arthritis.