Incomplete femoral neck fractures are often stress-fractures, but sometimes caused by low energy trauma (fall). Would it make sense to have the same management for both types of fractures? I.e. early operation when on tension side, conservative management when on compression side?
Always err on the side of operative management, because we are not going to lose anything if you fix the neck percutaneously in such cases with CC screws, but if we do not fix, there are always chances though minimal of Displacement, AVN.
Conservative treatment. The first thing is to avoid load for six weeks, according to the DXA star treatment and if there is nor inrease of pain repeat XR at three and six weeks, and start the march with supports.
First, we have to remember that we are treating a patient not only a fracture. So, many patients factors determine the best treatment. For example, patient demand like occupation, is an important factor. If the patient has a high demand occupation ( e.g. important diplomatic) and cannot wait for six weeks or more non weight bearing, it is better to go for operative fixation. Other patients factors include: medical status, bone quality, weight,..
That depends on the economic situation of each country or region. In theory you are absolutely right but in practice it is different.
In this case we should always rule out any systemic pathology. If there is no other pathology then compression site fractures less than 50 percent of neck width heal with non weight bearing protocol. Compression side fractures more than 50 percent of neck width and tensile surface fractures require screw fixation.
According to the general conditions of the patient, entry screws or a prosthesis (total or partial) can be chosen..
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