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

Kanu Okike, MD, MPH; Ian G. Hasegawa, MD


J Am Acad Orthop Surg. 2021;29(4):e154-e164. 

In This Article


The surgical management of nondisplaced FN fractures in the elderly should be approached with careful planning. Although current classification systems do not emphasize fracture displacement in the sagittal plane, a shoot-through lateral radiograph should be an essential implant of the surgical planning process, with particular attention paid to the degree of posterior tilt (ie, apex anterior angulation or retroversion). All presumed occult fractures should be confirmed with an MRI.

Although internal fixation is still considered standard of care for treating nondisplaced FN fractures in the elderly, notable rates of revision surgery and other complications have been documented. As a result, primary arthroplasty has emerged as a viable treatment for this injury. Further research is required to determine the optimal roles of internal fixation and arthroplasty in the management of Garden I and II FN fractures in the elderly.