The ‘Unsolved’ Fracture Neck of Femur– A Comprehensive Review

Introduction: Fractures involving the neck of the femur constitute a small proportion of total fractures in the body. Though these fractures mainly occur in the elderly population, their occurrence in youngsters due to high-velocity trauma is not uncommon. These fractures are commonly termed the ‘unsolved fractures’ as the outcome of these fractures are highly variable. The peculiar anatomy and precarious blood supply to the proximal femur and intracapsular location create an unfavourable biological environment for fracture union. The lack of prospective clinical trials which have evaluated the ideal surgical timing, technique and construct of the implant further adds to the confusion. Discussion: The aim of this review was to go through the recent relevant literature on the management of femoral neck fractures to find out the answers to the debated questions and to summarize the current diagnostic and management approaches to a patient with a suspected fracture neck of the femur. Conclusion: Knowing the patient and fracture related factors which influence the outcome are extremely important to achieve the goal of early uncomplicated fracture healing. This would help the surgeon in the thoughtful selection of the operative intervention for each patient on an individual basis and facilitate a thorough discussion between the surgeon and the patient which is vital in decision making. Keywords: Closed reduction, Hemiarthroplasty, Hip fractures, Intracapsular, Neck of Femur, Pauwel