Current Trends in the Evaluation and Management of Nondisplaced Femoral Neck Fractures in the Elderly.

Nondisplaced (Garden I and II) femoral neck (FN) fractures are commonly encountered by the practicing orthopaedic surgeon. Although these fractures are primarily classified based on the AP radiograph, the lateral radiograph should be closely scrutinized as well because posterior tilt has emerged as a consistent predictor of fixation failure. Internal fixation has for many years been the standard of care, with both cannulated screws and the sliding hip screw representing acceptable options. However, the outcomes after fixation of Garden I and II FN fractures have not been uniformly positive, with the rates of revision surgery ranging from 8% to 27%. Complications after fixation of nondisplaced FN fractures include nonunion, fixation failure, osteonecrosis, and femoral shortening causing inferior hip function. For these reasons, arthroplasty is increasingly considered a viable option in the treatment of these fractures, especially in the presence of factors that predispose to failure after fixation. Novel devices for FN fixation have recently been developed, although clinical data supporting their use are sparse at the present time.