Introduction:

The surgical management of femoral neck fractures is a critical aspect of orthopedic care, aimed at restoring the structural integrity and function of the hip joint. This article provides a comprehensive overview of the surgical management of femoral neck fractures, including the procedures involved, surgical approaches, and important considerations for optimal outcomes.

Understanding Femoral Neck Fractures:

• Definition: Femoral neck fractures occur when the femoral neck, the area connecting the femoral head to the shaft of the femur, is fractured due to trauma or underlying bone diseases.
• Significance: These fractures can disrupt blood supply to the femoral head, potentially leading to avascular necrosis and hip joint complications if not properly managed.

Surgical Procedures for Femoral Neck Fractures:

• Internal Fixation: This procedure involves stabilizing the fracture using various implants, such as screws, plates, or nails, to hold the fractured bone fragments in place while they heal.
• Hemiarthroplasty: Hemiarthroplasty involves replacing the femoral head with a prosthetic component, while retaining the patient's natural acetabulum. This is typically done in cases where the blood supply to the femoral head is compromised or in older patients with pre-existing joint diseases.
• Total Hip Arthroplasty: Total hip arthroplasty is a surgical procedure that involves replacing both the femoral head and the acetabulum with prosthetic components, providing a complete artificial hip joint.

Surgical Approaches for Femoral Neck Fractures:

• Anterolateral Approach (Watson-Jones Approach): This approach involves accessing the femoral neck fracture from the side of the hip through a surgical incision along the front and side of the thigh.
• Posterior Approach (Moore or Kocher-Langenbeck Approach): The posterior approach accesses the femoral neck fracture through a surgical incision along the back of the hip, providing good exposure to the fracture site.
• Lateral Approach (Hardinge Approach): The lateral approach involves accessing the femoral neck fracture from the side of the hip through a surgical incision along the lateral aspect of the thigh.

Considerations for Surgical Management:

• Patient Factors: Age, overall health, activity level, and pre-existing conditions play a role in determining the most suitable surgical management approach for femoral neck fractures.
• Fracture Type and Displacement: The type and degree of fracture displacement, as seen on imaging studies, help guide the choice of surgical procedure and fixation methods.
• Blood Supply Considerations: The blood supply to the femoral head is crucial in determining the choice of surgical management, as compromised blood flow may require more extensive procedures, such as hip arthroplasty.
• Surgeon's Experience: The surgeon's experience and expertise in specific surgical techniques and approaches influence the decision-making process and the ultimate choice of surgical management.

Postoperative Rehabilitation:

• Physical Therapy: Postoperative rehabilitation, including physical therapy, is crucial to optimize recovery, regain mobility, and strengthen the hip joint.
• Weight-Bearing Instructions: Weight-bearing status and activity restrictions are determined by the surgeon based on the specific surgical procedure performed and the patient's individual circumstances.

Conclusion:

The surgical management of femoral neck fractures is aimed at restoring the structural integrity and function of the hip joint. Various surgical procedures, such as internal fixation, hemiarthroplasty, or total hip arthroplasty, are chosen based on the specific fracture characteristics, patient factors, and the surgeon's expertise. The choice of surgical approach, such as anterolateral, posterior, or lateral, also depends on several factors. Proper postoperative rehabilitation is essential for optimal recovery and functional outcomes. Close collaboration between the patient, orthopedic surgeon, and rehabilitation team is vital to achieving successful outcomes in the surgical management of femoral neck fractures.

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