With the development of aging society, the incidence of femoral neck fractures in the elderly is increasing day by day. Femoral neck is one of the most common fracture sites in the elderly, and three methods are commonly used for clinical surgical treatment, including internal fixation, artificial femoral head replacement and artificial total hip replacement. However, internal fixation has the defects of non-healing fracture and long-term femoral head necrosis, which can be avoided by artificial joint replacement. Many systemic disorders that occur in the elderly can easily cause fractures, such as osteoporosis, diabetes, hypertension, pneumonia, cardiovascular disease, and urinary tract infections. These disorders can increase the risk of surgery. Therefore, in order to avoid the risk of surgery and to meet the basic needs of life, it is important to choose a simple surgical procedure as much as possible. From July 2004 to June 2010, the Department of Orthopaedics, Baicheng Hospital, Jilin Province, used artificial femoral head replacement to treat 30 cases of femoral neck fractures in the elderly, and achieved good results, which are reported below. Zhao Weigang, Department of Orthopaedics, Baicheng Hospital 1 Data and Methods 1.1 General Data In this group of 30 cases, there were 11 male and 19 female cases. The age ranged from 70 to 86 years old, with an average of (77.5±5.0) years old. From the causes of morbidity, 27 cases were injured by falls and 3 cases were injured by car accidents; 26 cases had fresh fractures and 4 cases had old fractures with non-healing bones. In terms of comorbidities, 11 cases had abnormal ECG, 9 cases had hypertension, 5 cases had diabetes, 4 cases had chronic bronchitis, 2 cases had emphysema, 2 cases had coronary heart disease, 2 cases had sequelae of cerebrovascular accident, and 1 case had Alzheimer’s disease. After admission, skin traction was performed on the affected limb, and all preoperative examinations were performed in the shortest possible time. In response to the individualized characteristics of the patients’ pre-injury comorbidities and preoperative examination abnormalities, the relevant departments were promptly invited to consult on the comorbidities and formulate individualized treatment plans. At the same time, after preoperative evaluation, surgery was performed as soon as possible when there were no absolute contraindications to surgery. In this group, the surgery was performed 3-5 d after admission.1.2 The surgical method used was continuous epidural or general anesthesia. Patients were placed in the healthy-side position, and the surgical incisions were all posterior-lateral hip incisions. The hip capsule was exposed and incised in the conventional way, the femoral head was removed, the femoral neck was truncated with a chainsaw about 1.5 cm above the lesser trochanter, the proximal femur was exposed, the medullary cavity of the femur was filed (using small to large size medullary files in sequence), the mold was tried, a suitable prosthesis was selected, the bone cement was injected into the medullary cavity with a bone cement gun, the femoral prosthesis was implanted, the bipolar femoral head was mounted, the joint was reset, and the head socket was After matching, local irrigation, placing one drainage tube in the incision, closing the incision in sequence, and the operation was completed.1.3 Postoperative treatment After the operation, the affected limb was kept in neutral, abducted and externally rotated position, and a soft pillow was placed between the legs to avoid inversion and internal rotation of the affected limb. To avoid the occurrence of infection, antibiotics were administered 30 min before the start of surgery and continued for 5~7 d. To prevent deep vein thrombosis in the lower limb, 5000 U of low molecular heparin calcium was injected subcutaneously every day for 7~12 d. The drainage tube was removed after 1~2 d. The patients were instructed to train active ankle extension and flexion and quadriceps isometric contraction activities in the first day after surgery, and active functional activities of the affected limbs from the second day onwards, and to stand at the bedside and walk slowly with the assistance of a walker or with the help of family members after 1 week. 2.2 Results 2.1 Observation of treatment results: 30 patients in this group were followed up for 6 months to 5 years. 20 patients in this group were excellent, 7 were good, 2 were acceptable, and 1 was poor. Follow-up radiographs showed one case of acetabular outer edge hyperplasia and one case of significant wear of the acetabular floor, without prosthesis sinking, without splitting of the upper femoral segment and prosthesis loosening. 2.2 Postoperative complications One case of cerebral embolism sequelae reappeared as a new infarct lesion in the second d after surgery, and was discharged in a stable condition after 4 weeks of medical treatment. One case of deep vein embolism in the lower extremity occurred in the lower leg of the affected limb, which was cured by thrombolytic drug treatment with elevation of the affected limb.3 Discussion Geriatric femoral neck fracture is one of the common and frequent diseases in orthopedics. After the fracture, how to make the elderly patients recover as soon as possible, reduce and minimize the emergence rate of complications and mortality is a difficult problem for orthopedic surgeons to solve. In the past, conservative treatment or various internal fixation surgical methods were used, but their clinical application was limited by the long duration of the disease, the tendency of complications such as decubitus ulcers, lung and urinary system infections after long-term bed rest, and the high occurrence of bone discontinuity and femoral head necrosis. Although the development of anesthesia and surgical techniques has improved the safety of surgery in elderly patients. With the maturity and development of artificial joint materials, processes and technologies, artificial joint replacement is widely used in elderly patients with femoral neck fractures. Domestic studies [2] have shown that the treatment of choice for elderly femoral neck fractures is artificial joint replacement because it can reduce the occurrence of complications, substantially reduce mortality, and enable patients to get out of bed early and resume self-care as soon as possible. It is true that most elderly patients with femoral neck fractures have a combination of chronic diseases, but with active perioperative management, patients can generally be cured successfully. Therefore, with the current level of medical technology, age is no longer a contraindication to surgery. Therefore, as long as there are no other obvious contraindications to surgery, a comprehensive preoperative systemic examination and effective medical treatment, it is advisable to perform artificial femoral head replacement early. As long as intraoperative and postoperative monitoring is strengthened, the patient can generally pass through the perioperative period safely and ensure his physical and mental health. One of the factors for the occurrence of femoral neck fracture in the elderly is osteoporosis, and if the fracture occurs, the patient is generally unable to take care of himself, which will cause greater psychological and mental trauma and pain. At the same time, long-term bed rest complicated by bedsores, pneumonia and urinary tract infections not only brings high medical costs, but also can increase mortality. The advantages of artificial femoral head replacement for the treatment of femoral neck fracture in the elderly include rapid restoration of hip function, early bed-ridden activities, and reduction of the emergence of various complications. Before anesthesia and surgery, blood volume should be expanded, and the method of continuous epidural anesthesia with less disturbance and complications to the organism’s physiology should be used, with a small amount of multiple doses and continuous low-flow oxygen administration to reduce the impact of surgery on the patient. During surgery, blood pressure changes should be closely observed and dynamic ECG monitoring should be performed. The surgical approach is usually posterior or posterior-lateral to the hip joint because it causes less damage to the hip muscles and less bleeding, which facilitates smooth implantation of the prosthesis. As the elderly are usually combined with osteoporosis, in order to reduce the amount of bleeding when the hip cavity is enlarged, only the local enlargement of the narrow hip cavity is usually sufficient. When the prosthesis is implanted, the hip cavity should be completely filled with bone cement, which is especially suitable for elderly patients. After surgery, after clinical observation and follow-up, if the prosthesis does not loosen and sink, the efficacy is more satisfactory, and patients can get out of bed early and practice function with crutches on the ground in 2~3 weeks [3]. To reasonably determine the indications for artificial femoral head replacement for femoral neck fractures: (1) those who are over 70 years of age, combined with more serious chronic diseases and poorer surgical tolerance; (2) those who have less activity, poorer walking ability, smaller body mass and normal acetabulum before the injury; (3) those who have partial dysfunction of the affected limb before the injury; (4) those who are predicted to live <10 years after the fracture. The individualized situation of the patient should be taken into account, and high age is not an absolute indication for artificial femoral head replacement; the most important indicator for choosing hemi- or total hip replacement is the patient's pre-injury walking ability [4]. After bipolar artificial femoral head replacement for high age femoral neck fractures, especially Garden type III and IV subcapital fractures, the occurrence of nonunion of femoral neck fractures and aseptic necrosis of the femoral head is avoided, and the risks, pain and medical costs associated with secondary surgery are avoided, and early bed mobility and early return to self-care are possible, reducing bedridden complications and mortality. Some people believe that compared with total hip replacement, hemiarthroplasty is prone to acetabular cartilage wear and protruding displacement of the femoral head to the center of the acetabulum, so total hip replacement is advocated. However, since the bipolar artificial femoral head has a small range of motion when the internal joint motion is the main one, and a large range of motion when the extra-articular motion occurs, this can significantly reduce the wear on the acetabulum. Since elderly people are relatively inactive and some of them need to walk with crutches, the shorter operation time, less bleeding, relatively small operation risk and lower medical cost of hemiarthroplasty determine that bipolar artificial femoral head replacement is an effective treatment for femoral neck fracture in the elderly and is worthy of clinical application. References [1] Lin Dapeng. Treatment experience of 35 cases of artificial femoral head replacement for senior femoral neck fractures [J]. Clinical Medicine Practice, 2010, 19(4): 180-181.[2] Wang Yizheng, ed. Bone and joint injuries [M]. 4th edition. Beijing: People's Health Publishing House, 2007: 1175.[3] Wang Lei-ship, Li Cheng-hua, Ma Hong-hai. Artificial femoral head replacement for 48 cases of high-grade femoral neck fractures [J]. Journal of Modern Traditional Chinese and Western Medicine, 2009, 18(28): 3474.[4] Yang L X, Sang S J, Lin J H et al. Mid-term follow-up of bipolar artificial femoral head replacement with bone cement fixation for high-grade femoral neck fractures. Chinese Journal of Orthopaedic Surgery, 2009, 17(18): 1368-1370.