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Surgical Management of Hip Fractures: An Evidence-based Review of the Literature. I: Femoral Neck Fractures

Dr. Miyamoto is Sports Medicine Fellow, Steadman Hawkins Clinic, Vail, CO. Dr. Kaplan is Sports Medicine Fellow, Kerlan Jobe Orthopaedic Clinic, Los Angeles, CA. Dr. Levine is Adult Reconstructive Surgeon, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL. Dr. Egol is Chief of Fracture Service, Department of Orthopaedic Surgery, NYU–Hospital for Joint Diseases, New York, NY. Dr. Zuckerman is Professor and Chairman, Department of Orthopaedic Surgery, NYU–Hospital for Joint Diseases.

Dr. Egol or a member of his immediate family participates in a speakers bureau/makes paid presentations for Biomet; is an unpaid consultant for Biomet; has received research or institutional support from Biomet, Smith & Nephew, Stryker, and Synthes; and holds stock or stock options in Johnson & Johnson. Dr. Zuckerman or a member of his immediate family is affiliated with Neostem and Starmed as a board member, owner, officer, or committee member; has received royalties from Exactech; and has received research or institutional support from Exactech and Stryker. None of the following authors or a member of their immediate families has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Miyamoto, Dr. Kaplan, and Dr. Levine.

Reprint requests: Dr. Zuckerman, Department of Orthopaedic Surgery, NYU–Hospital for Joint Diseases, Suite 1402, 301 East 17th Street, New York, NY 10003.

"Surgical Management of Hip Fractures: An Evidence-based Review of the Literature. II: Intertrochanteric Fractures" will be published in the November 2008 issue of the Journal of the American Academy of Orthopaedic Surgeons.

During the past 10 years, there has been a worldwide effort in all medical fields to base clinical health care decisions on available evidence as described by thorough reviews of the literature. Hip fractures pose a significant health care problem worldwide, with an annual incidence of approximately 1.7 million. Globally, the mean age of the population is increasing, and the number of hip fractures is expected to triple in the next 50 years. One-year mortality rates currently range from 14% to 36%, and care for these patients represents a major global economic burden. Surgical options for the management of femoral neck fractures are closely linked to individual patient factors and to the location and degree of fracture displacement. Nonsurgical management of intracapsular hip fractures is limited. Based on a critical, evidence-based review of the current literature, we have found minimal differences between implants used for internal fixation of displaced fractures. Cemented, unipolar hemiarthroplasty remains a good option with reasonable results. In the appropriate patient population, outcomes following total hip arthroplasty are favorable and appear to be superior to those of internal fixation.