One of the most common but potentially disastrous fractures of the elderly is a fractured neck of the femur, a result of osteoporosis. Treatment includes the patient’s rehabilitation into the community, not just the surgery itself. Otherwise the fall and the fracture (whichever came first) may be the ‘straw that breaks the camel’s back’, condemning an elderly person living independently to a life in care or even premature death.

Sub-capital and per-trochanteric fractured neck of the femur

The blood supply to the head of the femur runs up the neck of the femur from a rim where the capsule of the hip joint attaches to the base of the neck of the femur. If the fracture is a sub-capital fractured neck of the femur, high under the head, then, in the elderly, the blood supply to the head is usually so badly compromised that even if the fracture is reduced, the head will die. The only choice in this case is to replace the femoral head. The acetabulum is not affected, so only one-half of the joint is replaced. This is called a hemi-arthroplasty.

However, if the fracture is outside the insertion of the capsule at the base of the neck or even through the greater and lesser trochanter, the blood supply to the femoral head is unaffected. However, the fracture is very unstable, so it is usually fixed with a large screw inserted up the femoral neck, which is then attached to a plate fixed to the outside of the upper femur using screws. This system of fixation is called a dynamic hip screw because the screw impaling the neck and head of the femur can slip down onto the plate fixed to the upper femur allowing the fracture to compress and bed down. This improves the strength of the fixation and encourages early healing.