Femoral neck fractures are often clinically classified into four types according to the degree of fracture injury (Garden’s typing): (1) Type I is an incomplete fracture. (2) Type II is a complete fracture without displacement. (3) Type III is a complete fracture with partial displacement and partial insertion of the fracture end, abduction of the femoral head, and mild external rotation and superior displacement of the femoral neck segment. (4) Type IV is a completely displaced fracture with significant external rotation and upward displacement of the femoral neck segment. The articular capsule and synovial membrane are severely damaged. Type I and II are stable fractures because the fracture ends are not displaced or are less displaced and the fracture damage is less; Type III and IV are unstable fractures because the fracture ends are more displaced and the fracture damage is greater. Treatment 1 Non-surgical treatment 1.1 Chinese herbal medicine treatment Activate blood and spend silt to relieve swelling and pain in the early stage: relax the tendons and activate the collaterals in the middle stage, nourish the qi and blood; tonify the liver and kidney in the late stage, strengthen the tendons and bones. 1.2 Those with symptoms and signs, but negative X-ray films, should be reviewed after 2W of bed rest. 1.3 Patients or family members who refuse surgery; elderly patients with multi-system coexisting disorders who cannot tolerate surgery; children with Garden type I-II fractures. Adopt wearing a thong shoe ,
The patient should be treated with skin traction or bone traction to keep the injured limb in abducted neutral position. 2 Surgical treatment 2.1 Hollow screw internal fixation: Garden type I-II fracture (except for children!) 2.2 Closed reduction hollow screw fixation: Garden III-IV fractures; Garden III-IV fractures in young adults and children. 2.3 Incisional reduction, hollow screw internal fixation with musculocutaneous flap or vascular-tipped bone flap graft: femoral neck fractures in young adults. 2.4 Bipolar artificial femoral head replacement:
Elderly or frail patients, those with short expected survival (within 5 to 10 years), patients with Garden III-IV fractures without contraindications to surgery; severe osteoporosis of the proximal femoral neck,
Patients with severe osteoporosis of the proximal end of the femoral neck, difficult to perform internal fixation or unable to satisfactorily reposition internal fixation, or those who have lost use of internal fixation. 2.5 Artificial total hip arthroplasty: Patients aged 60-75 years with Garden III-IV fractures; a few elderly people aged 75 years or older who are in good health are also indications for total hip arthroplasty.