In clinical work and in our life, we often encounter such situations: elderly people suddenly fall down inadvertently due to slippery roads or unstable walking, and immediately feel pain in their hips and dare not move their lower limbs, and are found to have hip fractures (femoral neck fracture or intertrochanteric fracture) in hospital. The doctor will often recommend surgery, but the elderly are old, often combined with hypertension, diabetes, coronary heart disease and other geriatric diseases, the elderly themselves and their families are afraid of surgery, afraid of too old to withstand surgery, but also afraid that without surgery the elderly will not be able to walk on the ground, can only spend the rest of their lives in a wheelchair, in the end how to do? Now I will analyze the treatment of femoral neck fractures in the elderly after a fall, and how to choose a femoral neck fracture in the elderly. 1.What is a femoral neck fracture? Femoral neck fracture is a fracture between the lower femoral head and the base of the femoral neck, which is a common and frequent clinical disease and can be seen in all ages, with the highest incidence in middle-aged and elderly patients. In clinical practice, according to the location of the fracture line, it is mostly divided into: subtrochanteric, transcranial and basal types. 2. Why are elderly people prone to femoral neck fractures? Generally speaking, there are two main factors that cause femoral neck fractures in the elderly: First, elderly people, especially elderly women, have different degrees of osteoporosis, and the degree of osteoporosis is generally proportional to their age. The decrease of bone strength in the elderly, coupled with the dense nourishing vascular pores in the upper femoral neck area, can lead to the weakening of the femoral neck’s own biomechanical structure, the fragility of the femoral neck and osteoporosis, which can easily lead to femoral neck fracture under the action of external forces (such as falls), which is the main factor of femoral neck fracture in the elderly. Secondly, because the strength of the muscles around the hip joint decreases in the elderly, the muscle groups degenerate, and the response is slow, they cannot effectively counteract the harmful stress of the instantaneous burst of the hip, plus the hip is subjected to greater stress (2-6 times of body weight), and the local stress is complex and variable, so it does not need much violence, such as slipping on a flat surface, falling from a bed or a sudden twisting of the lower limbs, and even fractures can occur without obvious trauma. 3.What are the clinical manifestations of femoral neck fracture in the elderly? Symptoms: Elderly people feel pain in the hip immediately after a fall and are afraid to stand and walk. Signs: (1) Deformity: The affected limb has mild hip flexion and knee flexion and external rotation deformity. (2) Pain: In addition to spontaneous pain in the hip, the pain is more obvious when the affected limb is moved. Pain is also felt in the hip when the affected limb is tapped at the heel or the greater trochanter, and there is often pressure pain below the midpoint of the inguinal ligament. (3) Functional impairment: Most patients cannot sit up or stand up after the injury, but there are some nondisplaced linear fractures or embedded fractures that can still walk or even ride a bicycle after the injury. Special attention should be paid to these patients to avoid delaying the consultation because of “good activity”, because such non-displaced fractures will gradually become displaced fractures with activity and produce severe pain and activity impairment after a certain activity. 4.Why is conservative treatment not recommended for femoral neck fractures in the elderly? The so-called conservative treatment refers to the use of skin traction and other methods, or just bed rest, braking the affected limb, allowing the fracture end of the femoral neck to heal on its own. Some elderly people tend to choose this conservative treatment method because they think they are too old and usually have poor health, or they are resistant to the surgery itself and are afraid that they cannot bear the surgery. Unbeknownst to them, elderly people have a higher rate of non-healing of femoral neck fractures due to their poor healing ability due to osteoporosis and declining nutrition; moreover, femoral neck fractures affect the blood supply to the femoral head, and there is a higher incidence of femoral head necrosis in elderly people with femoral neck fractures. In addition, if conservative treatment, the elderly need absolute bed rest for at least 3 months. For the elderly, long time bed rest is very easy to occur complications such as crushing pneumonia, decubitus ulcer, deep vein thrombosis of the lower limbs, etc. For the elderly who are already frail and sick, these complications are undoubtedly fatal, therefore, we recommend surgery for femoral neck fracture in the elderly, as long as the physical condition allows. 5.What kind of surgery should be performed for femoral neck fracture in the elderly? There are many surgical methods for femoral neck fracture, such as hollow screw fixation, plate screw fixation and artificial hip replacement. For the elderly, due to the osteoporosis, the plate and screw holding force is insufficient, the plate or screw fixation effect is poor, and there is a risk of fracture non-healing and femoral head necrosis. Therefore, for complete femoral neck fractures in elderly people over 65 years old, we recommend artificial hip replacement surgery and choose total hip replacement or artificial femoral head replacement according to the patient’s age, acetabular development and degree of osteoporosis. Artificial hip arthroplasty is one of the most successful surgeries at present, using artificial materials to replace the diseased hip joint, fully simulating the structural characteristics of the normal hip joint and restoring its motor function. Its treatment effect has been fully affirmed after more than 30 years of clinical practice, which can effectively relieve joint pain, correct deformity, restore and improve the motion function of the joint, quickly eliminate the pain caused by the above-mentioned disease to patients, and significantly improve their quality of life. Patients can go down to the ground on the 1st day after surgery, effectively avoiding the complications brought by long-term bed rest for the elderly. Therefore, elderly people with femoral neck fracture should not be accommodated at home, and age is not an issue. As long as the patient is able to move around on his own before the fracture and does not have particularly serious multi-system diseases, artificial hip replacement treatment is feasible.