The treatment of displaced femoral neck fracture in a young patient is closed reduction (or open if necessary) associated with internal fixation, but what to do in the case with pre-existence of osteoarthritis?
Dear Nelson,
The decision making depends on the severity of the osteoarthritis. If it is an advanced coxarthritis with all inconveniences associated with it, then primary THR (cementless) is indicated in spite of the age of the patient.The risks of non-union, avascular necrosis of the femoral head and the increased infection risk after an eventual THR at a second stage some years after the internal fixation should be taken into consideration. I would not hesitate to propose THR to this patient.
I would tend to agree with Dr Panayot entirely. The fracture is an acute event in an arthritic hip. All attempts are made to achieve union in the absence of a symptomatic osteoarthritis. It would be better not to treat the Xray.
Dear Nelson,
the situation you descibe is rather atypic: 1. Why does a so young patient suffer from a femoral neck fracture? 2. In case of coxarthritis fracture pattern is normally per-/subtrochanteric (at least in the elderly patient). Is there any hint for a pathologic fracture.
If the trauma is adequate and there is no pathologic fracture around I would also tent to implant a THA (fixation depends on surgeon experience and with what kind of implant he is familiar). I would strongly recommend to use in implant system with a proven track record, nothing unprooven.
Dear Martin
A femoral neck fracture in a young patient without high energy trauma is a rare condition. In this case the patient had an osteoarthritis of the hip joint due LCP disease. My option was a non cemented THR .
Thank you for your opinion
Dear Martin,
I stopped my attention on your statement "if ...there is no pathologic fracture around it...". I hope you mean a benign condition (solitary cyst, aneurysmal cyst and similar tumor-like diseases). However, if a pathologic fracture is caused by maligancy, then THR or tumor prosthesis is also indicated.
In traumatic fractures I would perform THA if the osteoarthritis is at an advanced stage or if the patient had groin pain prior to his current injury. Another question is why would someone that young have an osteoarthritis? Is there a history of alcohol or steroid abuse, transplantation/immunosuppressants, history of trauma or dislocation etc. that could have caused an AVN or osteoarthritis?
This is important, because known alcohol abuse, kidney or liver insufficiency are risk factors for non-union and avn after internal fixation. In tendency, they would be indications to go for THA, also in younger patients with only slight joint degeneration.
Thank you for this interesting question.
Dear Maximilian
Thank you very much for your important opinion
Best regards
If the patient had symptomatic osteoarthritis in the hip before the injury, then uncemented hip replacement, otherwise osteosynthesis.
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