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Neck of femur fracture

131 citationsUpdated Sep 2026

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Overview

Femoral neck fractures must be evaluated against a background of impaired bone density and poor general health, rather than viewed in isolation as purely mechanical fixation problems [3]. While observed excellent functional outcomes at mid-term follow-up support joint-preserving strategies in non-geriatric patients [2], the literature lacks assessment of clinically relevant outcomes, making it challenging to guide clinical practice [1]. Standardization toward optimal outcomes is required, particularly given that low rates of osteoporotic pharmacotherapy persist despite established guidelines [10, 7]. For patients aged over 90 years, arthroplasty is more likely to improve long-term survival than nonoperative treatment [13]. Although total hip arthroplasty offers advantages, femoral neck fractures remain a major risk factor for long-term complications [15]. Patients can be reassured that care for geriatric femoral neck fractures yields comparable outcomes regardless of surgeon subspecialty [62].

Treatment decisions are heavily influenced by patient-related factors, with appropriate fracture reduction significantly associated with a lower reoperation risk [67]. Displaced femoral neck fractures in young patients require urgent treatment to prevent osteonecrosis and improve functional outcome [30]. If internal fixation is used for displaced fractures, patient selection is essential [71]. The necessity for preoperative dipyridamole-thallium scanning in elderly patients should be re-evaluated, as it increases the delay until surgery [35]. The potential advantages of the posterior approach have not been demonstrated, and its continued use is advised against [36]. Excessive femoral neck collapse of more than 15 mm is associated with an increased risk of fracture healing complications and increased loss of function [6].

Internal fixation remains the standard of care for nondisplaced femoral neck fractures in the elderly, though notable rates of revision surgery and complications have been documented [39]. Primary operative stabilization of undisplaced femoral neck fractures is recommended [74]. Compared to previously published reoperation rates for internal fixation, hip arthroplasty is a reasonable treatment option for nondisplaced fractures to potentially decrease reoperations in a frail patient population [63]. There appears to be no justification for the use of more than three pin/screw implants, as increasing the number did not significantly improve stability [70]. Selective use of cementless femoral fixation in patients younger than 65 years did not result in an increased risk of revision or reoperation at 10 years compared to cemented fixation [142]. Autologous bone cylinder transplantation with cannulated screw re-stabilisation should be considered for selected young patients with delayed fracture healing [22]. The outcome of the DEFENDD trial will provide high-level evidence on which implant is favourable for young patients (≤65 years) [52]. Limited small trials have attempted to determine the optimum surgical implant for young femoral neck fractures, and considerable controversy remains in the literature and among practicing surgeons [144]. Non-randomized studies provided results dissimilar to randomized trials of arthroplasty versus internal fixation for mortality and revision rates [73].

Anatomy & Pathophysiology

Bony Anatomy

The hip is a multiaxial joint formed by the articulation between the pelvis and femur, connecting the axial skeleton and the lower extremity [85]. The hemipelvis comprises the ilium, ischium, and pubis, which unite at the triradiate cartilage within the concave acetabulum [85]. The acetabulum consists of an articular crescent-moon–shaped lunate surface and a nonarticular central fossa that serves as the attachment point for the ligamentum teres [85]. The femoral head forms two-thirds of a sphere, featuring a small central depression from which the ligamentum teres extends to connect to the acetabular notch [85].

The femoral neck-shaft angle averages 125° [85], with a mean adult value of 130° ± 7° [95] and an average of 127 degrees that begins at 141 degrees in the fetus [91]. Normal version, defined as the head-neck angle in the frontal plane, averages 15 to 20° [85]. The mean anteversion of the femoral neck is 10° ± 7° [95], while the femoral neck is normally anteverted approximately 14 degrees in relation to femoral condyles, with a range of 1–40 degrees [91]. The acetabulum is normally anteverted 15 degrees and obliquely oriented in the coronal plane 45 degrees caudally [91].

The weakest area in the femoral neck is located in the Ward triangle [95]. The calcar femorale is a medial area of dense trabecular bone that transfers stress from the femoral shaft to the inferior portion of the femoral neck [95]. Fractures of the proximal femur follow the path of least resistance, and the amount of energy absorbed by the bone determines the degree of comminution [95].

Ligaments and Capsule

The hip is surrounded by a dense fibrous capsule extending from the periphery of the acetabulum to the intertrochanteric line of the femoral neck [85]. The hip capsule attaches anteriorly and posteriorly along the periphery of the acetabulum outside the labrum [86]. On the femoral side, the capsule attaches anteriorly along the intertrochanteric crest [86]. Posteriorly, the attachment is partial, such that the basicervical region of the femoral neck and the intertrochanteric region of the femur are not intracapsular [86].

The primary ligaments supporting the hip include: Iliofemoral ligament: Also known as the Y ligament of Bigelow, it originates at the AIIS and inserts at the intertrochanteric line [86]. It is the thickest and strongest of the three main ligaments [85] and becomes taut in full extension, preventing anterior dislocation and hyperextension [86]. Ischiofemoral ligament: Reinforces the posterior capsule and provides a check to internal rotation of the hip [86]. Pubofemoral ligament: Attaches to the inferior and medial part of the capsule and may cause a hip adduction contracture [86].

The twisted orientation of these hip ligaments provides a screw mechanism for the hip in full extension [86]. The ligamentum teres originates in the cotyloid fossa and attaches on the fovea of the femoral head [86]. It transmits an arterial branch of the posterior division of the obturator artery to the femoral head, which is less significant in adults [82].

Vascular Anatomy

The medial femoral circumflex artery is the main blood supply to the femoral head [95]. It terminates in the posterior aspect of the extracapsular arterial ring, while the lateral femoral circumflex artery gives rise to the anterior aspect of this ring [95]. The superior and inferior gluteal arteries also contribute branches to the extracapsular arterial ring [95].

The ascending cervical arteries originate from the extracapsular arterial ring and are divided into four distinct groups based on their anatomic relationship to the femoral neck: lateral, medial, posterior, and anterior [95]. The lateral group of ascending branches is the main blood supply to the femoral head [95]. These ascending branches give off multiple perforator vessels to the femoral neck and terminate in the subsynovial arterial ring located at the margin of the articular surface of the femoral head [95]. The lateral epiphyseal artery penetrates the femoral head and is believed to be the dominant blood supply to the femoral head from this system [95].

Fractures that disrupt the ascending blood flow to the lateral epiphyseal vessel have an increased risk of osteonecrosis [95]. The artery of the ligamentum teres arises from either the obturator or medial femoral circumflex artery and does not provide sufficient blood supply to maintain the viability of the femoral head [95]. In adulthood, the major blood supply to the femoral head is from the medial femoral circumflex and lateral epiphyseal arteries [99]. From the age of 4 years to adulthood, the posterosuperior and posteroinferior retinacular arteries from the medial circumflex artery are the major blood supply to the femoral head [99].

Pathophysiology of Fracture Healing

Femoral neck fractures are considered intracapsular fractures, which are at higher risk of nonunion [95]. Because of the absence of a periosteal or extraosseous blood supply, no callus forms during healing; the intracapsular portion of the femoral neck has essentially no cambium layer in its fibrous covering to participate in external callus formation [95, 65]. Consequently, fracture healing occurs by intraosseous bone healing [95].

The viability of the femoral head after a femoral neck fracture is dependent on preservation of the remaining vascular supply and on revascularization and repair of the necrotic areas before collapse of the necrotic bone segment can occur [65]. To preserve the remaining blood supply to the displaced femoral head, accurate reduction and stable fixation is critical in any attempt to salvage the femoral head [65]. An important source of revascularization is the vascular ingrowth across the uniting fracture line [65]. Transverse shear and rotational interfragmentary movement caused by poor fracture stabilization are deleterious to revascularization as they disrupt angiogenesis in the femoral head [65].

Decreased or absent vascularity of the femoral head is seen in approximately 75% of femoral neck fractures [65]. However, 80% of femoral heads with initial vascular compromise seem to regain blood flow within six weeks [65]. The (re)vascularization of the femoral head is further compromised when using implants with larger volumes, as this may increase the incidence of avascular necrosis [65].

Femoral neck fractures in physiologically young patients typically occur from high-energy axial loading forces through the thigh with the hip in an abducted position [75]. High-energy femoral neck fractures have a high rate of associated head, chest, abdominal, and musculoskeletal injuries [75]. Treatment failure is frequently seen after femoral neck fractures, including nonunion, failed fixation, osteonecrosis, and malunion [19]. Understanding and addressing the pathoanatomy of vertical femoral neck fractures is mandatory to minimize risks for treatment failure [19]. Quality reduction and stable fixation for femoral neck fractures are vital elements in managing these at-risk fractures [19].

Irreducible femoral neck fractures are defined as those with great difficulty in achieving anatomical reduction after routine closed reduction, such as the Whitman manoeuvre or Leadbetter manoeuvre, with the patient under general anaesthesia [76]. One mechanism for irreducible femoral neck fractures is when the proximal fragment disconnects entirely from the distal femur as a 'floating' femoral head, making alignment of the distal to proximal femur difficult [76]. Another mechanism is when the proximal segment impacts into the distal part after rotation and moves along with the distal part as one unit [76]. The detachment of the proximal segment from the capsule, commonly seen in subcapital femoral neck fractures, can lead to the uncontrolled rolling motion of the proximal segment within the capsule, making it very difficult to obtain anatomic reduction [76].

The characteristic differences between femoral neck fractures in young adult patients and typical osteoporotic femoral neck fractures contribute to a specific set of clinical problems [19]. The morphological diversity and complexity within femoral neck fractures in young and middle-aged adults allow for more accurate simulation of femoral neck fracture patterns in future biomechanical studies [77].

Classification

Reliability and Validity of Classification Systems

The Garden classification is the most commonly used system for femoral neck fractures, despite poor interobserver reliability [105]. In a study evaluating reliability among orthopaedic trauma surgeons and residents, the four-stage Garden classification demonstrated an overall reliability of 0.33 (fair agreement) [175]. The AO classification showed an overall agreement of 0.22 (fair agreement) in the same cohort [175]. Consequently, the four-stage Garden and AO classifications should be avoided in clinical use because of poor reproducibility [175].

A simplified two-category system dividing fractures into displaced versus nondisplaced shows better reliability than the full Garden classification [105]. Better reliability was found for the classification of femoral neck fractures simply as 'non-displaced' or 'displaced' [123]. The most reproducible classification system divides cervical hip fractures into undisplaced (33%) and displaced (67%) [96]. A simple two-stage classification provided the highest reliability estimates, ranging from 0.35 (fair agreement) to 0.83 (almost perfect agreement), with multi-rater agreement of 0.50 (moderate agreement) [175]. Only the simple two-stage classification showed sufficient intra- and interobserver reliability in a study comparing Garden, AO, and simple II stage classifications [175].

Specific Classification Schemes and Definitions

Garden: An undisplaced intracapsular fracture is defined as Garden Grade I and Grade II fractures [55]. Garden Grade I fractures are defined as impacted into any degree of valgus [55]. Garden Grade II fractures are defined as completely undisplaced [55]. Garden Type I is an incomplete fracture [190]. Garden Type II is a complete fracture without displacement [190]. Garden Type III is a fracture with partial displacement, abduction of the femoral head, mild external rotation, and upward displacement of the femoral neck segment [190]. Garden Type IV is a complete displacement of the femoral neck, being significantly externally rotated and upward [190].

AO: Undisplaced intracapsular fractures also correspond to AO types 31.B1.1, B1.2, and B1.3 [55].

Modified Pauwels: The modified Pauwels classification includes Type I, Type II, and Type III categories [189]. In a study of 209 patients, 37 were classified as modified Pauwels type I, 106 as type II, and 66 as type III [189]. The biomechanical and clinical dominance of positive buttress correlates with Pauwels type, being biomechanically stable in Pauwels types I and II but not advantageous in type III [80].

Epidemiology and Demographics

The incidence of femoral neck fractures rose from 0.43/10^3 population among those less than 60 years old to over 20/10^5 among those over 90 [33]. Patients between 55 and 70 years with displaced femoral neck fractures are epidemiologically similar to older patients with femoral neck fractures [18]. The frequency of failure following femoral neck fractures does not seem to differ between persons under or over the age of 50 years [9]. Femoral neck fractures are devastating injuries in the young adult population [12]. Young adult femoral neck fracture management remains a challenge for practicing orthopaedic surgeons [14].

Associated Injuries and Diagnostic Considerations

Undisplaced femoral neck fractures can be difficult to diagnose [11]. Most ipsilateral femoral neck and shaft fractures are diagnosed during the evaluation of the injured patient [25]. Reducing the frequency of missed diagnoses of ipsilateral femoral neck and shaft fractures is dependent on maintaining a high index of suspicion [25]. Encountering a high-energy comminuted midshaft femoral fracture should occasion vigilance for an associated femoral neck fracture [25]. The presence of an ipsilateral knee injury should alert the treating physician to search for a femoral neck fracture [25].

A full profile of the femoral neck requires internal rotation of the leg due to the natural anteversion of the femoral neck [25]. In the presence of a shaft fracture, internal rotation is often impossible, which may account for the initial failure to recognize some nondisplaced neck fractures [25]. Motorcycle collisions were the strongest predicting mechanism for ipsilateral femoral neck fractures in a study of femoral shaft fractures [78]. The incidence of nonunion after sustaining a combined femoral shaft and femoral neck fracture has been reported at 5% [78]. Osteonecrosis rates range from 15% to 30% after sustaining a combined femoral shaft and femoral neck fracture [78].

The risk factors for a subcapital femoral neck fracture following successful trochanteric fracture treatment include being of advanced age, female, osteoporotic bones, having a small femoral head and neck, and having a basicervical type of primary fracture [17]. The identification of a pre-existing fractured neck of femur will obviously greatly alter the surgical management of the patient especially with regard to the type of fixation device to be used [50].

Other Considerations

Spontaneous femoral neck fracture exhibits internal heterogeneity based on its different causes [34]. The morphological diversity and complexity within femoral neck fractures in young and middle-aged adults allows for more accurate simulation of femoral neck fracture patterns in future biomechanical studies [77].

Clinical Presentation

History and Mechanism

Most patients with femoral neck fractures report a history of a traumatic event, with the exception of those who have stress fractures of the femoral neck [113]. In young patients with high-energy femoral neck fractures, associated injuries such as head trauma may preclude the ability to provide a history [113]. The index of suspicion for this injury must remain extremely high, as the consequences of a missed femoral neck fracture can be disastrous [113]. Fractures in patients 60 years of age or younger represent challenging injuries due to high-energy trauma mechanisms and the displaced fracture patterns typically found in this population [16].

Spontaneous subcapital femoral neck fractures can develop after a healed intertrochanteric hip fracture, with a high grade of osteoporosis being the most important predisposing factor [31]. Risk factors for subcapital femoral neck fracture following successful trochanteric fracture treatment include advanced age, female sex, osteoporotic bones, a small femoral head and neck, and a basicervical type of primary fracture [17]. In pediatric patients, both the injury mechanism and fracture characteristics exhibit age-related distributions [118].

Physical Examination

The physical examination typically reveals an extremity that is shortened and externally rotated [113]. Factors associated with frailty, including visual impairment, gait problems, deficiencies of proprioception and balance, and osteoporosis, make this demographic particularly prone to falls and low-energy fractures [106]. The "Chin-on-Chest in Neck of Femur Fracture" (COCNOF) sign serves as a radiographic predictor of frailty and mortality in hip fracture patients [106].

Diagnostic Challenges

Diagnostic delays are common; in a study of 1108 consecutive patients, 154 experienced a delay of 24 hours or more from symptom onset to diagnosis [24]. Reasons for this delay included the patient not seeking medical assistance in 63 cases (40.9%), delay in referral by the general practitioner in 36 cases (23.3%), failure to establish the diagnosis in the Accident and Emergency department in 23 cases (14.9%), and other hospital medical staff in 32 cases (20.8%) [24]. Among 91 patients seen by a doctor, 60 did not have X-rays in the first 24 hours [24]. In nine patients whose initial X-rays were considered completely normal after diagnosis was established, six had a fracture that displaced before diagnosis, one had the fracture confirmed by isotope bone scan, and two by repeat X-rays before any fracture displacement occurred [24].

Due to the natural anteversion of the femoral neck, a full profile of the neck requires internal rotation of the leg [25]. If a patient has persistent complaints of ipsilateral hip pain after treatment of a shaft fracture, the hip should be further evaluated [25]. Failure to detect and appropriately treat an acetabular fracture may lead to significant complications such as femoral neck fracture [49]. Identifying a pre-existing fractured neck of femur greatly alters surgical management, especially regarding the type of fixation device used [50]. There were no cases of missed or delayed femoral neck fractures in patients with a negative MRI for high-energy femoral shaft fractures [51].

MRI has become the imaging study of choice to evaluate occult femoral neck fractures [113]. CT scans can yield useful information, including the degree of comminution [113]. Bone scintigrams during the first 6 months after operation do not reliably predict failure of internal fixation of fractures of the neck of the femur [32].

Radiographic and Classification Features

Standard anteroposterior pelvic and cross-table lateral views of the hip are necessary for diagnosis [113]. A traction internal rotation view is often helpful for diagnosis [113]. The cross-table lateral view is probably essential in enabling prediction of failure with fixation in Garden I and II femoral neck fractures [113].

Garden Classification: * Grade I: Impacted into any degree of valgus [55]. * Grade II: Completely undisplaced [55]. * Grade III: Complete fracture of the femoral neck with partial displacement, internal rotation of the fractured femoral head, mild upward and external rotation of the femoral neck, and discontinuity of trabecular lines between the intra-articular pressure bone of the femoral head and the acetabulum [116].

This review illustrated previously undescribed appearances following intracapsular femoral neck fractures, demonstrating that all theoretical outcomes are possible [28].

Prognostic Indicators

Several baseline factors were identified as being associated with lower health-related quality of life, hip function, and utility after a femoral neck fracture [8]. Patients with a femoral neck fracture exhibit marked osteopenia irrespective of treatment [57].

Investigations

Plain radiography: Conventional radiographs remain critical in the initial imaging evaluation of the hip [42]. A complete hip series usually consists of an anterior-posterior (AP) pelvis, a centered AP hip, a lateral view (frog-leg, cross-table, Dunn 45° or 90°), and a false-profile (Lequesne) view [42]. An anteroposterior radiograph of the pelvis is essential in all femur fractures to avoid missing associated femoral neck fractures [177]. The modified lateral view can obtain a standard sagittal image of the femoral neck, clearly showing dislocation and angulation of sagittal femoral neck fractures, and improve diagnostic accuracy [197]. Preoperative radiographic signs evaluated in displaced femoral neck fractures do not sufficiently determine the decision to treat with prosthesis or internal fixation [205]. There is no significant association between posterior multifragmentation of the femoral neck observed on preoperative radiography and the later development of fracture healing complications [217]. Unusual appearances following intracapsular neck of femur fractures demonstrate that all theoretical outcomes are possible [28].

MRI: MRI is the modality of choice for patients suspected of soft tissue or intra-articular pathology, given its superior sensitivity and specificity [103]. MRI is more sensitive than bone scan for ruling out occult nondisplaced stress fractures if the injury is less than 24 hours old [100]. MRI diagnosed occult femoral neck fractures not found on 12% of thin cut CT scans [47]. There were no cases of missed or delayed femoral neck fractures in patients with a negative MRI following a novel protocol for high-energy femoral shaft fractures [51]. The use of the CT capsular sign with lipohemarthrosis as a selective indicator for preoperative hip MRI or prophylactic femoral neck fixation is effective for preventing unplanned surgery due to delayed diagnosis of occult ipsilateral femoral neck fractures [215]. MRI is helpful in identifying femoral neck stress fracture in athletes and predicting patients that may require surgical intervention [109].

CT: CT scans are effective for examining cortical and cancellous bone and can be used to create three-dimensional reconstructions of the hip for use in surgical planning [103]. CT overcomes the limitations of radiography by providing three-dimensional assessment of bony morphology [87]. CT is helpful in fracture evaluation, particularly in the setting of negative radiographs, or for further defining fracture morphology in patients requiring surgical reduction [87]. CT scan does not bear sufficient sensitivity to detect all occult hip fractures [196]. Advanced imaging of Garden I/II femoral neck fractures objectively increases the number of fractures considered too unstable for internal fixation [194]. Routine additional methods of image investigation of femoral neck fractures may be unnecessary for diaphyseal fractures type A1 and A2 [143].

Bone scan: Scintimetry is a useful tool in predicting poor outcome due to femoral head necrosis and/or non-union in the treatment of intracapsular hip fractures [219]. Early scintigraphic patterns after osteosynthesis of femoral neck fractures have to be validated with care [173].

Other Considerations: A thorough history is essential to differentiating between common causes of hip pain, and clinical examination tests and imaging findings should be used to confirm a suspected clinical diagnosis [41]. Findings from imaging studies should complement clinical examination findings to provide the most accurate diagnosis [41]. The complexity of the hip and pelvic region can make accurate diagnosis of painful conditions difficult [41]. Failure to detect and appropriately treat an acetabular fracture may lead to significant complications such as femoral neck fracture [49]. Motorcycle collisions were the strongest predicting mechanism for ipsilateral femoral neck fractures in patients with femoral shaft fractures [78]. Osteonecrosis rates for combined femoral shaft and femoral neck fractures range from 15% to 30% [78]. Objective sound wave analysis may be used as a diagnostic test or screening tool in the assessment of occult hip fractures and could serve as a substitute for MRI scans [213]. Ultrasonography cannot image inside bone because bone cortex reflects almost all sound waves [110]. Ultrasonography provides real-time dynamic assessment of the hip and is useful in diagnosing soft-tissue abnormalities about the hip joint [87].

In a cohort of 1108 patients, 154 patients experienced a delay of 24 hours or more from the onset of symptoms to diagnosis [24]. Of the 91 patients seen by a doctor in the delayed diagnosis cohort, 60 did not have X-rays in the first 24 hours [24]. In 9 patients from the delayed diagnosis cohort, initial X-rays were considered completely normal upon review after the diagnosis of a hip fracture was established [24]. Of the 9 patients with initially normal X-rays in the delayed diagnosis cohort, 6 had a fracture that displaced before the diagnosis [24]. In 3 cases from the delayed diagnosis cohort where the fracture was visible on the first radiograph, it was felt to be barely visible, necessitating additional investigations [24].

Treatment

General Principles and Outcomes

Assessment of clinically relevant outcomes in the young femoral neck fracture literature is lacking, making it challenging to use the literature to guide clinical practice [1]. Treatment failure is frequently seen after femoral neck fractures in young adults, including nonunion, failed fixation, osteonecrosis, and malunion [19, 44]. The cornerstone of managing femoral neck fractures in the non-elderly population is anatomical reduction and stable internal fixation of the femoral neck, in an attempt to salvage the femoral head [139]. Internal fixation remains an effective option in select clinical circumstances for femoral neck fractures [152]. Hip function in patients with femoral neck fracture surgery delayed over 21 days recovered more slowly than that in those who underwent surgery within 7 days [21].

Non-Operative

In undisplaced intracapsular femoral neck fractures, there is a higher prevalence of nonunion, avascular necrosis, and fracture displacement in nonoperatively treated fractures [117]. Nonoperative management of proximal femoral fractures is associated with a higher mortality rate [117]. However, non-operative management appears to remain a viable treatment option for non-osteoporotic patients with Garden I femoral neck fractures with a risk of secondary displacement close to 10% [108]. One study concludes that non-operative treatment of impacted femoral neck fractures is justified for most patients, sparing 69% an unnecessary operation [137]. Conversely, surgery to treat undisplaced femoral neck fractures was associated with a higher union rate and a tendency toward less avascular necrosis than conservative treatment [160], leading some authors to recommend primary operative stabilization of undisplaced femoral neck fractures [74]. Successful conservative treatment of undisplaced femoral neck stress fractures in children with autosomal dominant osteopetrosis is possible [167].

Operative

Indications: The review recommends treating displaced femoral neck fractures on an urgent basis to prevent osteonecrosis and improve functional outcome [30]. In patients aged 65 years or younger, internal fixation after reduction for severe valgus-impacted femoral neck fractures is safe and effective for achieving successful bone union and restoring the femoral neck length [128]. Pre-existing osteoarthritis is not a contraindication to hemiarthroplasty in elderly patients with femoral neck fracture [129].

Surgical Approach / Technique: For closed reduction and fixation of displaced femoral neck fractures in young adults, an inferior cortical buttress reduction pattern, though non-anatomic, can produce sustainable fracture stability and predictable clinical outcomes [171]. The viability of the femoral head after femoral neck fracture is dependent on preservation of the remaining vascular supply and on revascularization and repair of the necrotic areas before collapse of the necrotic bone segment can occur [65]. The transverse shear and the rotational interfragmentary movement caused by poor fracture stabilization are deleterious to revascularization as they disrupt angiogenesis in the femoral head [65]. Decreased or absent vascularity of the femoral head is seen in approximately 75% of femoral neck fractures, whereas 80% of femoral heads with initial vascular compromise seem to regain blood flow within six weeks [65].

Implant Selection: Femoral neck system (FNS) has excellent biomechanical properties and shows significantly higher overall construct stability compared to cannulated compression screws [20]. In the management of Pauwels type III femoral neck fractures in young patients, FNS demonstrates clinical efficacy comparable to cannulated compression screws [48]. The femoral neck system alone or combined with a cannulated screw demonstrated better short-term efficacy in the treatment of femoral neck fractures [53]. For young and middle-aged patients with femoral neck fractures, both FNS and cannulated screws combined with a medial plate are effective [122]. FNS presented satisfactory outcomes with a significantly lower complication rate, therefore, can be one of the alternatives for internal implantation devices in treatment of femoral neck fracture in non-geriatric population [131]. Dynamic compression system and multiple cancellous screws demonstrated effectiveness in treating femoral neck fractures in young adults [111]. Patients receiving the combination strategy of fibula allograft with cannulated screw fixation have faster and high-quality functional recovery after femoral neck fractures and a lower incidence rate of postoperative complications compared to ordinary cannulated screw fixation [125]. Cannulated screws with deep circumflex iliac artery-bone grafting is a feasible and effective method in the treatment of young adult patients with femoral neck fracture [23]. Compression supporting screws demonstrated beneficial outcomes in terms of effectively enhancing the recovery of patients with femoral neck fracture and reducing the associated complications [133]. Internal fixation remains a simple and safe method of treatment for both undisplaced and displaced femoral neck fractures in middle-age patients [64].

Arthroplasty: The potential advantages of the posterior approach have not been demonstrated after femoral neck fractures and surgeons are advised against its continued use for hemiarthroplasty [36]. Providers may choose the method of arthroplasty stem fixation for the treatment of femoral neck fracture based on what they deem most appropriate for the specific patient [141]. Total hip arthroplasty after failed internal fixation of femoral neck fracture is a well tolerated and effective procedure in older and younger patients [127].

Outcomes and Complications: Reoperation was not infrequent following internal fixation of apparently non-displaced femoral neck fractures in elderly patients [40]. The risk of reoperation and mortality following the treatment of nondisplaced femoral neck fractures in the elderly with internal fixation exceeds 14% [161]. Patients with femoral neck fractures treated with internal fixation achieved good functional outcomes, but the majority did not regain their pre-fracture health-related quality of life at 24-month follow-up [26]. Treatment of femoral neck fractures in patients fifty years old or less yielded very good results overall, and even the occurrence of osteonecrosis did not necessarily cause an unsatisfactory result [38].

Salvage and Revision: Femoroacetabular impingement may be a less common but potential cause of delayed union or non-union in the setting of femoral neck fracture in the young [5]. Valgus osteotomy is a good option for non-union of neck of femur in young adults [176]. Valgus intertrochanteric osteotomy and fibular strut graft is recommended for neglected femoral neck fractures [134]. The clinical indications for implant removal in healed pertrochanteric fractures are not well established and should be restricted to specific cases [130].

Complications

Young Patients (≤60 years)

The literature regarding clinically relevant outcomes in young femoral neck fractures is insufficient to reliably guide clinical practice [1]. These injuries present significant treatment challenges due to high-energy trauma mechanisms and displaced fracture patterns [16]. In patients fifty years old or less, treatment yielded very good overall results, and the occurrence of osteonecrosis did not necessarily result in an unsatisfactory outcome [38]. For Pauwels type III fractures in young patients, femoral neck system (FNS) and cemented sliding hip screw (CSMP) fixation demonstrated similar long-term functional outcomes and complication rates [66]. Osteosynthesis using the femoral neck system showed favorable clinical outcomes, with no specific hardware-related complications reported during follow-up [68].

Elderly Patients (>60 years)

The incidence of femoral neck fractures rises sharply with age, increasing from 0.43/10³ population in those under 60 to over 20/10⁵ in those over 90 [33]. Approximately 1 in 6 patients survive at least 10 years following a hip fracture [29]. Despite the advantages of total hip arthroplasty (THA), femoral neck fractures remain a major risk factor for long-term complications [15]. In a seventeen-year study of healthy elderly patients with displaced femoral neck fractures, total hip replacement provided better hip function and significantly fewer reoperations compared with internal fixation, without increasing mortality [61]. Subsequent fractures, including second hip fractures, occurred frequently and early following an index femoral neck fracture in two large global cohorts [4]. Patients sustaining a distal femoral fracture share a similar adverse event profile with those sustaining a femoral neck fracture [60].

Fracture Healing and Structural Complications

Collapse of the femoral neck following an intracapsular hip fracture has a detrimental effect on outcome [69].

Diagnostic and Preoperative Factors

In a cohort of 154 patients with fractured neck of femur, diagnosis was delayed by 24 hours or more from symptom onset [24]. The primary reasons for this delay included patients not seeking medical assistance (63 cases, 40.9%), delay in referral by the general practitioner (36 cases, 23.3%), failure to establish the diagnosis in the Accident and Emergency department (23 cases, 14.9%), and other hospital medical staff (32 cases, 20.8%) [24]. Among 91 patients seen by a doctor, 60 did not have X-rays within the first 24 hours [24]. Of the 31 patients who underwent X-ray, one set of original films could not be found for review [24]. In nine patients, initial X-rays were considered completely normal upon review after diagnosis was established [24]. Of these nine, six had fractures that displaced before diagnosis, one was confirmed by isotope bone scan, and two were confirmed by repeat X-rays before displacement occurred [24]. For the remaining 21 patients who were X-rayed, the fracture was visible on the first radiograph in all cases [24]. In three of these 21 cases, the fracture was barely visible, necessitating additional investigations such as isotope bone scans [24].

General Considerations

Patients between 55 and 70 years with displaced femoral neck fractures are epidemiologically similar to older patients with femoral neck fractures [18].

Recovery

Functional Outcomes and Quality of Life: In active patients within the studied age group, total hip replacement provides better functional outcomes than internal fixation for femoral neck fractures [56]. For the majority of elderly patients with displaced femoral neck fractures, bipolar hemiarthroplasty serves as a definitive treatment with high long-term survivorship [132]. In cases of neglected femoral neck fracture, bipolar hemiarthroplasty yields satisfactory outcomes and predictable, reproducible functional recovery, although long-term results remain to be established [135].

Complications and Failure Modes: Femoroacetabular impingement (FAI) represents a less common but potential cause of delayed union or non-union in young patients with femoral neck fractures [5]. Abnormal radiographic findings do not alter the treatment course when the patient history and physical examination are normal [222].

Secondary Fracture Risk and Bone Health: Risk factors for a subcapital femoral neck fracture following successful treatment of a trochanteric fracture include advanced age, female sex, osteoporotic bones, a small femoral head and neck, and a basicervical type of primary fracture [17]. This patient group is epidemiologically similar to older patients presenting with femoral neck fractures [18].

Survival and Mortality: Median survival in male fracture patients decreased from 5.2 years in age-matched controls to 1.6 years, while for female subjects it decreased from 6.6 to 2.8 years [221].

Surgical Timing and Technique: Comparative studies have evaluated short-term costs and reoperation risks within a 3-year period for geriatric femoral neck fractures treated with hemiarthroplasty versus total hip arthroplasty [59]. For selected young patients with delayed fracture healing of the femoral neck, the majority of patients are treated successfully, indicating that this technique should be considered an alternative treatment option [22]. Through years of experience and method modification tailored to the individual patient and fracture, authors have achieved an early complication rate of less than 6% [220].

Key Evidence

• [L1] The assessment of clinically relevant outcomes in the young femoral neck fracture literature is lacking, which makes utilising the literature to guide clinical practice challenging. [1] (10.1016/j.injury.2014.11.020)
• [L4] Nonetheless, observed excellent functional outcome at mid-term follow-up supports joint-preserving strategies in non-geriatric femoral neck fractures. [2] (10.1007/s00402-018-3011-0)
• [L4] The study emphasizes that femoral neck fractures should not be viewed in isolation as purely mechanical fixation problems but must be contemplated against a background of impaired bone density and poor general health. [3] (10.1016/0020-1383(76)90041-3)
• [L2] Subsequent fractures, including second hip fractures, occurred frequently and early following an index femoral neck fracture in 2 large global cohorts. [4] (10.2106/jbjs.22.00088)
• [Case_report] FAI may be a less common but potential cause of delayed union or non-union in the setting of femoral neck fracture in the young. [5] (10.1007/s00402-015-2186-x)
• [Paper] Excessive femoral neck collapse (more than 15 mm) is associated with an increased risk of fracture healing complications and increased loss of function. [6] (10.1016/j.injury.2016.10.021)
• [L1] Standardization toward optimal outcomes for femoral neck fractures is needed. [7] (10.1016/j.arth.2011.06.025)
• [L2] Several baseline factors were identified as being associated with lower health-related quality of life, hip function, and utility after a femoral neck fracture. [8] (10.1302/0301-620x.100b3.bjj-2017-0853.r1)
• [L4] The frequency of failure following femoral neck fractures does not seem to differ between persons under or over the age of 50 years. [9] (10.1016/0020-1383(82)90049-3)
• [L3] Despite established guidelines, low rates of osteoporotic pharmacotherapy were seen in patients who had femoral neck fractures. [10] (10.1016/j.arth.2025.07.028)
• [L4] Undisplaced femoral neck fractures can be difficult to diagnose. [11] (10.1016/0020-1383(92)90054-v)
• [L5] Femoral neck fractures are devastating injuries in the young adult population. [12] (10.1016/j.injury.2014.11.015)
• [L3] Arthroplasty is more likely to improve long-term survival in femoral neck fracture patients aged over 90 years than nonoperative treatment. [13] (10.1186/s12891-020-03249-7)
• [L5] Young adult femoral neck fracture management remains a challenge for practicing orthopaedic surgeons. [14] (10.1016/j.injury.2014.11.017)
• [L3] Despite the advantages of THA, femoral neck fractures remain a major risk factor for long-term complications. [15] (10.1016/j.arth.2024.09.012)
• [L1] [16] (10.1016/j.injury.2014.10.010)
• [L5] The risk factors for such a complication include being of advanced age, female, osteoporotic bones and having a small femoral head and neck, as well as a basicervical type of primary fracture. [17] (10.1016/s0020-1383(11)70117-6)
• [L3] This suggests that this patient group is epidemiologically similar to older patients with femoral neck fractures. [18] (10.1186/s12891-019-2732-8)
• [L3] FNS has excellent biomechanical properties and shows significantly higher overall construct stability. [20] (10.1186/s13018-021-02517-z)
• [L3] Hip function in patients with femoral neck fracture surgery delayed over 21 days recovered more slowly than that in those who underwent surgery within 7 days. [21] (10.1186/s12891-020-03521-w)
• [L4] The majority of patients were treated successfully, indicating that this technique should be considered as an alternative treatment option for selected young patients with delayed fracture healing of the femoral neck. [22] (10.1007/s00402-011-1344-z)
• [L3] Therefore, it is a feasible and effective method in the treatment of young adult patients with femoral neck fracture. [23] (10.1016/j.injury.2018.06.014)
• [L2] [24] (10.1016/s0020-1383(96)00198-2)
• [L4] [25] (10.5435/00124635-199803000-00005)
• [L3] Patients with femoral neck fractures treated with internal fixation achieved good functional outcomes, but the majority did not regain their pre-fracture health-related quality of life at 24-month follow-up. [26] (10.1016/j.injury.2017.10.028)
• [L4] This review illustrated previously undescribed appearances following intracapsular femoral neck fractures, demonstrating that all theoretical outcomes are possible. [28] (10.1016/j.injury.2011.05.012)
• [L3] Approximately 1 in 6 patients live at least 10 years following a hip fracture. [29] (10.2106/jbjs.24.00379)
• [L4] The review recommends treating displaced femoral neck fractures on an urgent basis to prevent osteonecrosis and improve functional outcome. [30] (10.5312/wjo.v5.i3.204)
• [L3] A high grade of osteoporosis is the most important predisposing factor in the spontaneous development of a subcapital femoral neck fracture after a healed intertrochanteric hip fracture. [31] (10.1007/s004020050408)
• [L1] Bone scintigrams during the first 6 months after operation do not reliably predict failure of internal fixation of fractures of the neck of the femur. [32] (10.1016/0020-1383(87)90382-2)
• [L4] The incidence of femoral neck fractures rose from 0.43/103 population among those less than 60 years old to over 20/105 among those over 90. [33] (10.1016/0020-1383(77)90062-6)
• [L3] Spontaneous femoral neck fracture exhibits internal heterogeneity based on its different causes. [34] (10.1186/s12891-023-07058-6)
• [L3] The necessity for DTS should be re-evaluated in elderly patients with femoral neck fractures, given that this increases the length of the delay until surgery. [35] (10.1186/s13018-020-01918-w)
• [L3] The potential advantages of the posterior approach have not been demonstrated after femoral neck fractures and we advise against its continued use. [36] (10.1016/j.injury.2017.03.024)
• [L4] Treatment of femoral neck fractures in patients fifty years old or less yielded very good results overall, and even the occurrence of osteonecrosis did not necessarily cause an unsatisfactory result. [38] (10.2106/00004623-198567080-00018)
• [L4] Internal fixation remains the standard of care for nondisplaced femoral neck fractures in the elderly, but notable rates of revision surgery and complications have been documented. [39] (10.5435/jaaos-d-20-00349)
• [L3] Reoperation was not infrequent following internal fixation of apparently non-displaced femoral neck fractures in elderly patients. [40] (10.1016/j.arth.2023.06.035)
• [L3] In the management of Pauwels type III femoral neck fractures in young patients, FNS demonstrates clinical efficacy comparable to CCSs. [48] (10.1186/s13018-025-05461-4)
• [L5] Failure to detect and appropriately treat an acetabular fracture may lead to significant complications such as the femoral neck fracture in our patient. [49] (10.1016/s0020-1383(97)00145-9)
• [L5] The identification of a pre-existing fractured neck of femur will obviously greatly alter the surgical management of the patient especially with regard to the type of fixation device to be used. [50] (10.1016/0020-1383(95)90055-1)
• [L4] There were no cases of missed/delayed femoral neck fractures in patients with a negative MRI. [51] (10.1016/j.injury.2021.05.009)
• [L1] The outcome of the DEFENDD trial will provide high-level evidence of which implant is favourable for the treatment of femoral neck fractures in young patients (≤65 years). [52] (10.1186/s12891-020-3131-x)
• [L3] The femoral neck system alone or combined with a cannulated screw demonstrated better short-term efficacy in the treatment of femoral neck fractures. [53] (10.1186/s12891-023-06959-w)
• [L3] [55] (10.1097/01.blo.0000119459.00792.c1)
• [L5] [56] (10.2106/jbjs.l.01064)
• [L2] Patients with a femoral neck fracture exhibit marked osteopenia irrespective of treatment, implying they are more sensitive to osteopenia than patients undergoing THA for arthrosis, where no bone loss occurs. [57] (10.1007/bf00387579)
• [L3] The study compared short-term costs and reoperation risks within the 3-year period for geriatric femoral neck fractures treated with hemiarthroplasty or total hip arthroplasty. [59] (10.1186/s12891-026-09598-z)
• [L3] Patients who sustain a distal femoral fracture share a similar adverse event profile with those patients who sustain a femoral neck fracture. [60] (10.1177/2151458515608225)
• [L1] Over a period of seventeen years in a group of healthy, elderly patients with a displaced femoral neck fracture, total hip replacement provided better hip function and significantly fewer reoperations compared with internal fixation without increasing mortality. [61] (10.2106/jbjs.k.01615)
• [L3] The authors state that patients can be reassured that their care for geriatric femoral neck fractures yields comparable outcomes. [62] (10.5435/jaaosglobal-d-25-00103)
• [L3] Compared to previously published reoperation rates of internal fixation of nondisplaced femoral neck fractures, hip arthroplasty is a reasonable treatment option for nondisplaced femoral neck fractures to potentially decrease reoperations in a frail patient population. [63] (10.1016/j.arth.2023.04.010)
• [L4] Internal fixation remains a simple and safe method of treatment for both undisplaced and displaced femoral neck fractures in middle-age patients. [64] (10.1016/s0020-1383(02)00367-4)
• [L4] [65] (10.1302/0301-620x.100b4.bjj-2016-1098.r3)
• [L3] FNS and CSMP demonstrated similar long-term functional outcomes and complication rates in young patients with Pauwels type III femoral neck fractures. [66] (10.1186/s12891-025-08910-7)
• [L4] Outcomes for patients with femoral neck fractures are influenced by patient-related factors, and appropriate fracture reduction is significantly associated with a lower reoperation risk. [67] (10.2106/jbjs.18.00733)
• [L4] Osteosynthesis of femoral neck fractures using the newly introduced femoral neck system showed favorable clinical outcomes and no specific hardware-related complications were reported during the follow-up. [68] (10.1186/s12891-023-07113-2)
• [Paper] Collapse of the femoral neck after an intracapsular hip fracture has a detrimental effect on outcome. [69] (10.1016/s0020-1383(12)70066-9)
• [L5] There appears to be no justification for the use of more than three pin/screw implants for management of femoral neck fractures as increasing the number of implants did not significantly improve stability. [70] (10.1002/jor.1100050316)
• [L3] If internal fixation is to be used for a displaced femoral neck fracture, patient selection is essential. [71] (10.1186/s12891-018-2120-9)
• [L3] Non-randomized studies provided results dissimilar to randomized trials of arthroplasty vs internal fixation for mortality and revision rates in patients with femoral neck fractures. [73] (10.1007/s00402-003-0559-z)
• [L3] The authors recommend primary operative stabilization of undisplaced femoral neck fractures. [74] (10.1016/s0020-1383(96)00073-3)
• [L5] [75] (10.5435/jaaos-d-23-00720)
• [Paper] [76] (10.1016/j.injury.2010.05.008)
• [L4] The present study highlights the morphological diversity and complexity within femoral neck fractures in young and middle-aged adults, which allows for more accurate simulation of femoral neck fracture patterns in future biomechanical studies. [77] (10.1186/s12891-024-07207-5)
• [L3] [78] (10.5435/jaaosglobal-d-24-00012)
• [L3] The biomechanical and clinical dominance of positive buttress correlates with Pauwels type; it is biomechanically stable in Pauwels types I and II but not advantageous in type III. [80] (10.1186/s12891-024-07802-6)
• [L4] The most reproducible classification system divides cervical hip fractures into undisplaced (33%) and displaced (67%). [96] (10.1016/s0020-1383(02)00324-8)
• [L5] The Garden classification is the most commonly used system for femoral neck fractures despite poor interobserver reliability, with a simplified two-category system (displaced vs. nondisplaced) showing better reliability. [105] (10.1007/s11999.0000000000000066)
• [L3] [106] (10.1016/j.injury.2020.10.098)
• [Paper] Non-operative management appears to remain a viable treatment option for non-osteoporotic patients with Garden I femoral neck fractures with a risk of secondary displacement close to 10%. [108] (10.1007/s00402-014-2139-9)
• [L3] DCS and MCS demonstrated effectiveness in treating femoral neck fractures in young adults. [111] (10.1186/s13018-024-04913-7)
• [L4] [116] (10.1186/s13018-023-04269-4)
• [L3] For femoral neck fracture in pediatric patients, both the injury mechanism and fracture characteristics have age-related distributions. [118] (10.1186/s13018-020-01587-9)
• [L1] For young and middle-aged patients with femoral neck fractures, both FNS and CS combined with a medial plate are effective. [122] (10.1186/s13018-025-05972-0)
• [L4] Better reliability was found for the classification of femoral neck fractures simply as 'non-displaced' or 'displaced'. [123] (10.1016/j.otsr.2012.02.003)
• [L3] Patients receiving the combination strategy have faster and high-quality functional recovery after femoral neck fractures and a lower incidence rate of postoperative complications. [125] (10.1186/s13018-023-04002-1)
• [L3] THA after failed internal fixation of femoral neck fracture is a well tolerated and effective procedure in older and younger patients. [127] (10.1186/s13018-023-03827-0)
• [L3] In patients aged 65 years or younger, internal fixation after reduction for severe valgus-impacted femoral neck fractures is safe and effective for achieving successful bone union and restoring the femoral neck length. [128] (10.1016/j.injury.2020.10.028)
• [L3] Our findings challenge the hypothesis that pre-existing osteoarthritis is a contraindication to hemiarthroplasty in elderly patients with femoral neck fracture. [129] (10.1186/s12891-015-0767-z)
• [L4] The clinical indications for implant removal in healed pertrochanteric fractures are not well established and should be restricted to specific cases. [130] (10.1007/s00402-020-03435-1)
• [L3] FNS presented satisfactory outcomes with a significantly lower complication rate, therefore, can be one of the alternatives for internal implantation devices in treatment of femoral neck fracture in non-geriatric population. [131] (10.1186/s12891-023-06140-3)
• [L4] The long-term survivorship of bipolar hemiarthroplasty prostheses used to treat displaced femoral neck fractures in the elderly was high, and the procedure can be considered definitive for the majority of elderly patients with a femoral neck fracture. [132] (10.1007/s11999-015-4462-z)
• [L3] Our findings demonstrated beneficial outcomes obtained by using compression supporting screw, in terms of effectively enhancing the recovery of patients with femoral neck fracture and reducing the associated complications. [133] (10.1186/s13018-024-04873-y)
• [L3] We recommend this procedure for neglected femoral neck fractures. [134] (10.1016/j.injury.2012.09.014)
• [Case_report] Hemiarthroplasty bipolar give satisfactory outcome for neglected femoral neck fracture and provides a predictable, reproducible functional recovery although long-term results are yet to be seen. [135] (10.1177/2325967120s00056)
• [L2] The study concludes that non-operative treatment of impacted femoral neck fractures is justified for most patients, sparing 69% an unnecessary operation. [137] (10.1016/s0020-1383(02)00325-x)
• [L5] [139] (10.1016/j.injury.2014.12.031)
• [L3] Providers may choose the method of arthroplasty stem fixation for the treatment of femoral neck fracture based on what they deem most appropriate for the specific patient. [141] (10.1016/j.arth.2023.08.017)
• [L3] Selective use of cementless femoral fixation in patients younger than 65 years who had a femoral neck fracture did not result in an increased risk of revision or reoperation at 10 years compared to cemented fixation. [142] (10.1016/j.arth.2025.07.013)
• [L4] Routine additional methods of image investigation of femoral neck fractures may be unnecessary for diaphyseal fractures type A1 and A2. [143] (10.1016/j.injury.2021.01.040)
• [L4] Limited small trials have attempted to determine the optimum surgical implant for young femoral neck fractures, and considerable controversy remains in the literature and among practicing surgeons. [144] (10.1016/j.injury.2014.11.028)
• [L5] [152] (10.5435/00124635-200609000-00006)
• [L1] Surgery to treat undisplaced femoral neck fractures was associated with a higher union rate and a tendency toward less avascular necrosis than conservative treatment. [160] (10.1186/s13018-017-0528-9)
• [L1] The risk of reoperation and mortality following the treatment of nondisplaced femoral neck fractures in the elderly with internal fixation exceeds 14%. [161] (10.1016/j.injury.2019.09.039)
• [L4] Successful conservative treatment of undisplaced femoral neck stress fractures in children with autosomal dominant osteopetrosis is possible. [167] (10.1007/s00402-007-0392-x)
• [L4] For closed reduction and fixation of displaced femoral neck fractures in young adults, an inferior cortical buttress reduction pattern, though non-anatomic, can produce sustainable fracture stability and predictable clinical outcomes. [171] (10.1186/s13018-019-1109-x)
• [L2] Early scintigraphic patterns after osteosynthesis of femoral neck fractures have to be validated with care. [173] (10.1007/bf00393709)
• [L4] [175] (10.1016/j.otsr.2018.11.007)
• [L3] Valgus osteotomy is a good option for non-union of neck of femur in young adults. [176] (10.1016/s0020-1383(17)30486-2)
• [L4] The author concludes that an anteroposterior radiograph of the pelvis is essential in all femur fractures to avoid missing associated femoral neck fractures. [177] (10.1016/0020-1383(96)89813-5)
• [L3] [189] (10.1016/j.injury.2015.06.016)
• [L4] [190] (10.1186/s12891-023-06839-3)
• [L3] Therefore, advanced imaging of Garden I/II femoral neck fractures objectively increases the number of fractures considered too unstable for internal fixation. [194] (10.5435/jaaos-d-25-00669)
• [Paper] CT scan does not bear sufficient sensitivity to detect all occult hip fractures. [196] (10.1016/j.injury.2016.10.019)
• [L4] The modified lateral view can obtain a standard sagittal image of the femoral neck, clearly showing dislocation and angulation of sagittal femoral neck fractures, and improve diagnostic accuracy. [197] (10.1186/s13018-023-04183-9)
• [L4] The decision to treat an intracapsular femoral neck fracture with either prosthesis or internal fixation has to be based on other variables than the preoperative radiographic signs evaluated in this study. [205] (10.1007/s00402-006-0276-5)
• [L4] Objective sound wave analysis may be used as a diagnostic test or screening tool in the assessment of occult hip fractures and could serve as a substitute for MRI scans. [213] (10.1016/j.injury.2011.09.030)
• [L1] The use of the CT capsular sign with lipohemarthrosis as a selective indicator for preoperative hip MRI or prophylactic femoral neck fixation with a reconstruction nail in patients with high-energy femoral shaft fractures is effective for preventing unplanned surgery due to delayed diagnosis of occult ipsilateral femoral neck fractures. [215] (10.2106/jbjs.20.02033)
• [L3] Using current methods of internal fixation of intracapsular hip fractures, there is no significant association between the posterior multifragmentation of the femoral neck observed on preoperative radiography and the later development of fracture healing complications. [217] (10.1016/j.injury.2008.08.008)
• [L2] Scintimetry is a useful tool in predicting poor outcome due to femoral head necrosis and/or non-union in the treatment of intracapsular hip fractures. [219] (10.1007/bf00440592)
• [L4] The authors were able to achieve an early complications rate of less than 6% by acquiring many years of experience and by modifying the method to suit the individual patient and fracture. [220] (10.1016/s0020-1383(02)00327-3)
• [Paper] Median survival in male fracture patients was reduced from 5.2 years in age-matched controls to 1.6 years, and for female subjects from 6.6 to 2.8 years. [221] (10.1016/j.injury.2006.02.046)
• [L4] Abnormal radiographs do not change treatment course in the presence of a normal history and physical. [222] (10.1016/j.injury.2019.07.005)

See Also

• Femoroacetabular impingement
• Total hip replacement

References

[1] Young femoral neck fractures: Are we measuring outcomes that matter?. Injury. 2015. DOI: 10.1016/j.injury.2014.11.020

[2] Femoral shortening does not impair functional outcome after internal fixation of femoral neck fractures in non-geriatric patients. Archives of Orthopaedic and Trauma Surgery. 2018. DOI: 10.1007/s00402-018-3011-0

[3] Iatrogenic factors in femoral neck fractures. Injury. 1976. DOI: 10.1016/0020-1383(76)90041-3

[4] High Rates of Imminent Subsequent Fracture After Femoral Neck Fracture in the Elderly. Journal of Bone and Joint Surgery. 2022. DOI: 10.2106/jbjs.22.00088

[5] Femoroacetabular impingement inducing non-union of a femoral neck fracture: a case report. Archives of Orthopaedic and Trauma Surgery. 2015. DOI: 10.1007/s00402-015-2186-x

[6] Femoral neck collapse after internal fixation of an intracapsular hip fracture: Does it indicate a poor outcome?. Injury. 2016. DOI: 10.1016/j.injury.2016.10.021

[7] Variability in the Approach to Total Hip Arthroplasty in Patients With Displaced Femoral Neck Fractures. The Journal of Arthroplasty. 2012. DOI: 10.1016/j.arth.2011.06.025

[8] Factors associated with health-related quality of life, hip function, and health utility after operative management of femoral neck fractures. The Bone & Joint Journal. 2018. DOI: 10.1302/0301-620x.100b3.bjj-2017-0853.r1

[9] Femoral neck fractures in young adults. Injury. 1982. DOI: 10.1016/0020-1383(82)90049-3

[10] A Missed Opportunity? Osteoporosis Treatment Following Femoral Neck Fractures: Reducing the Risk of Secondary Hip Fracture. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2025.07.028

[11] Pitfalls in diagnosis of femoral neck fracture. Injury. 1992. DOI: 10.1016/0020-1383(92)90054-v

[12] Gaps and opportunities in the management of the young femoral neck fracture. Injury. 2015. DOI: 10.1016/j.injury.2014.11.015

[13] Long-term survival of femoral neck fracture patients aged over ninety years: Arthroplasty compared with nonoperative treatment. BMC Musculoskeletal Disorders. 2020. DOI: 10.1186/s12891-020-03249-7

[14] Anatomical considerations in adult femoral neck fractures: How anatomy influences the treatment issues?. Injury. 2015. DOI: 10.1016/j.injury.2014.11.017

[15] Increased Risk of 10-Year Revision Following Total Hip Arthroplasty for Femoral Neck Fracture. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2024.09.012

[16] Complications following young femoral neck fractures. Injury. 2015. DOI: 10.1016/j.injury.2014.10.010

[17] P13 Subcapital femoral neck fracture, following successful trochanteric fracture treatment with intramedullary nail: report of one case. Injury. 2011. DOI: 10.1016/s0020-1383(11)70117-6

[18] Low bone density and high morbidity in patients between 55 and 70 years with displaced femoral neck fractures: a case-control study of 50 patients vs 150 normal controls. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2732-8

[19] Chapter 35 Femoral Neck Fractures in the Younger Patient. 2021.

[20] Clinical outcome of femoral neck system versus cannulated compression screws for fixation of femoral neck fracture in younger patients. Journal of Orthopaedic Surgery and Research. 2021. DOI: 10.1186/s13018-021-02517-z

[21] Effects of delayed hip replacement on postoperative hip function and quality of life in elderly patients with femoral neck fracture. BMC Musculoskeletal Disorders. 2020. DOI: 10.1186/s12891-020-03521-w

[22] Autologous bone cylinder transplantation with cannulated screw re-stabilisation: a new treatment option for delayed fracture healing of the femoral neck. Archives of Orthopaedic and Trauma Surgery. 2011. DOI: 10.1007/s00402-011-1344-z

[23] Effect of cannulated screws with deep circumflex iliac artery-bone grafting in the treatment of femoral neck fracture in young adults. Injury. 2018. DOI: 10.1016/j.injury.2018.06.014

[24] Delayed diagnosis of femoral neck fractures. Injury. 1997. DOI: 10.1016/s0020-1383(96)00198-2

[25] Ipsilateral Femoral Neck and Shaft Fractures. Journal of the American Academy of Orthopaedic Surgeons. 1998. DOI: 10.5435/00124635-199803000-00005

[26] Good functional outcome but not regained health related quality of life in the majority of 20–69 years old patients with femoral neck fracture treated with internal fixation. Injury. 2017. DOI: 10.1016/j.injury.2017.10.028

[28] Unusual appearances following intracapsular neck of femur fractures. Injury. 2011. DOI: 10.1016/j.injury.2011.05.012

[29] Patient Factors Associated with 10-Year Survival After Arthroplasty for Hip Fracture. Journal of Bone and Joint Surgery. 2024. DOI: 10.2106/jbjs.24.00379

[30] Management of femoral neck fractures in the young patient: A critical analysis review. World Journal of Orthopedics. 2014. DOI: 10.5312/wjo.v5.i3.204

[31] Spontaneous subcapital femoral neck fracture complicating a healed intertrochanteric fracture. Archives of Orthopaedic and Trauma Surgery. 2005. DOI: 10.1007/s004020050408

[32] The predictive value of bone scintigraphy after internal fixation of femoral neck fractures. Injury. 1987. DOI: 10.1016/0020-1383(87)90382-2

[33] Femoral neck fractures. Injury. 1977. DOI: 10.1016/0020-1383(77)90062-6

[34] Spontaneous femoral neck fracture resulting from osteonecrosis involving lateral femoral head-neck junction: a retrospective study. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-023-07058-6

[35] Does preoperative dipyridamole-thallium scanning reduce 90-day cardiac complications and 1-year mortality in patients with femoral neck fractures undergoing hemiarthroplasty?. Journal of Orthopaedic Surgery and Research. 2020. DOI: 10.1186/s13018-020-01918-w

[36] Posterior versus lateral approach for hemiarthroplasty after femoral neck fracture: Early complications in a prospective cohort of 583 patients. Injury. 2017. DOI: 10.1016/j.injury.2017.03.024

[38] Femoral neck fractures in skeletally mature patients, fifty years old or less.. The Journal of Bone & Joint Surgery. 1985. DOI: 10.2106/00004623-198567080-00018

[39] Current Trends in the Evaluation and Management of Nondisplaced Femoral Neck Fractures in the Elderly. Journal of the American Academy of Orthopaedic Surgeons. 2020. DOI: 10.5435/jaaos-d-20-00349

[40] What is the Fate of Undisplaced Femoral Neck Fractures Treated With Cannulated Screws?. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2023.06.035

[41] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy and Biomechanics, Evaluation, Clinical Examination, and Imaging of the Hip > Summary.

[42] Orthopaedic Knowledge Update Sports Medicine 6. Imaging of the Hip > Radiography.

[44] Orthopaedic Knowledge Update Trauma. Femoral Neck Fractures in the Younger Patient > Summary.

[47] Orthopaedic Knowledge Update Trauma. Femoral Neck Fractures in the Geriatric Population > Annotated References.

[48] Femoral neck system (FNS) versus 4 cannulated compression screws (CCSs) in the treatment of young patients with Pauwels type III femoral neck fracture: a retrospective comparative study. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-05461-4

[49] Femoral neck fracture complicating a missed acetabular fracture in an elderly patient. Injury. 1998. DOI: 10.1016/s0020-1383(97)00145-9

[50] Femoral neck fracture: a complication of femoral nailing. Injury. 1995. DOI: 10.1016/0020-1383(95)90055-1

[51] Implementation of a novel MRI protocol for diagnosing femoral neck fractures in high energy femoral shaft fractures: One year results. Injury. 2021. DOI: 10.1016/j.injury.2021.05.009

[52] Study protocol for the DEFENDD trial: an RCT on the Dynamic Locking Blade Plate (DLBP) versus the Dynamic Hip Screw (DHS) for displaced femoral neck fractures in patients 65 years and younger. BMC Musculoskeletal Disorders. 2020. DOI: 10.1186/s12891-020-3131-x

[53] Superior short-term outcomes of FNS in combination with a cannulated screw in treating femoral neck fractures. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-023-06959-w

[55] Undisplaced Intracapsular Hip Fractures. Clinical Orthopaedics & Related Research. 2004. DOI: 10.1097/01.blo.0000119459.00792.c1

[56] Total Hip Replacement is Preferred for Displaced Femoral Neck Fracture in Selected Elderly Patients. Journal of Bone and Joint Surgery. 2012. DOI: 10.2106/jbjs.l.01064

[57] Bone and muscle mass after femoral neck fracture. Archives of Orthopaedic and Trauma Surgery. 1997. DOI: 10.1007/bf00387579

[59] Comparison of short-term costs and 3-year complications in geriatric femoral neck fractures: hemiarthroplasty versus total hip arthroplasty. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09598-z

[60] Comparison of Short-Term Outcomes of Geriatric Distal Femur and Femoral Neck Fractures. Geriatric Orthopaedic Surgery & Rehabilitation. 2015. DOI: 10.1177/2151458515608225

[61] Total Hip Replacement Versus Open Reduction and Internal Fixation of Displaced Femoral Neck Fractures. Journal of Bone and Joint Surgery. 2012. DOI: 10.2106/jbjs.k.01615

[62] The Correlation of Surgeon Subspecialty With Outcomes Following Surgery for Geriatric Femoral Neck Fracture. JAAOS: Global Research and Reviews. 2025. DOI: 10.5435/jaaosglobal-d-25-00103

[63] Displaced Versus Nondisplaced Femoral Neck Fractures: Is Arthroplasty the Answer for Both?. The Journal of Arthroplasty. 2023. DOI: 10.1016/j.arth.2023.04.010

[64] Long-term outcome of patients with avascular necrosis, after internal fixation of femoral neck fractures. Injury. 2003. DOI: 10.1016/s0020-1383(02)00367-4

[65] Displaced femoral neck fractures in patients 60 years of age or younger: results of internal fixation with the dynamic locking blade plate. The Bone & Joint Journal. 2018. DOI: 10.1302/0301-620x.100b4.bjj-2016-1098.r3

[66] Femoral neck system versus cannulated screws with a medial plate for the fixation of Pauwels type III femoral neck fractures in young patients: a retrospective cohort study. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08910-7

[67] Minimal Effect of Implant Position on Failure Rates in Femoral Neck Fractures. Journal of Bone and Joint Surgery. 2018. DOI: 10.2106/jbjs.18.00733

[68] Fixation of femoral neck fracture with femoral neck system: a retrospective cohort study of 43 patients. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-023-07113-2

[69] L-F5.3 Femoral neck collapse after internal fixation of intracapsular hip fractures. Injury. 2012. DOI: 10.1016/s0020-1383(12)70066-9

[70] Torsion and bending analysis of internal fixation techniques for femoral neck fractures: The role of implant design and bone density. Journal of Orthopaedic Research. 1987. DOI: 10.1002/jor.1100050316

[71] Suboptimal outcomes after closed reduction and internal fixation of displaced femoral neck fractures in middle-aged patients: is internal fixation adequate in this age group?. BMC Musculoskeletal Disorders. 2018. DOI: 10.1186/s12891-018-2120-9

[73] Hierarchy of evidence: differences in results between non-randomized studies and randomized trials in patients with femoral neck fractures. Archives of Orthopaedic and Trauma Surgery. 2003. DOI: 10.1007/s00402-003-0559-z

[74] Non-operative or operative treatment for undisplaced femoral neck fractures: a comparative study of 122 non-operative and 125 operatively treated cases. Injury. 1996. DOI: 10.1016/s0020-1383(96)00073-3

[75] High-energy Femoral Neck Fractures in Young Patients. Journal of the American Academy of Orthopaedic Surgeons. 2024. DOI: 10.5435/jaaos-d-23-00720

[76] An irreducible variant of femoral neck fracture: A minimally traumatic reduction technique. Injury. 2011. DOI: 10.1016/j.injury.2010.05.008

[77] Morphological characteristics of femoral neck fractures in young and middle-aged population: a retrospective descriptive study. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07207-5

[78] Characteristics of Femoral Shaft Fractures That Predict Ipsilateral Femoral Neck Fractures. JAAOS: Global Research and Reviews. 2024. DOI: 10.5435/jaaosglobal-d-24-00012

[80] Nonanatomical reduction of femoral neck fractures in young patients with different Pauwels classifications: a retrospective study and finite element analysis. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07802-6

[82] Miller S Review Of Orthopaedics. Genetics of musculoskeletal conditions and abnormalities are summarized in Table 1.27 > 2. Arthrology > Hip (Fig. 2.49).

[85] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy and Biomechanics, Evaluation, Clinical Examination, and Imaging of the Hip > Osseous and Ligamentous Anatomy.

[86] Aaos Comprehensive Orthopaedic Review 3. Surgical Anatomy of the Hip > IV. Hip Capsule and Ligaments.

[87] Orthopaedic Knowledge Update Sports Medicine 6. Imaging of the Hip > Introduction.

[91] Miller S Review Of Orthopaedics. SECTION 16 PATELLAR TRACKING IN TOTAL KNEE ARTHROPLASTY > LOWER EXTREMITY.

[95] Aaos Comprehensive Orthopaedic Review 3. Fractures of the Hip > I. General Considerations.

[96] Epidemiology of femoral neck fractures. Injury. 2002. DOI: 10.1016/s0020-1383(02)00324-8

[99] Aaos Comprehensive Orthopaedic Review 3. Surgical Anatomy of the Hip > VI. Neurovascular Structures Surrounding the Hip.

[100] Miller S Review Of Orthopaedics. SECTION 16 PATELLAR TRACKING IN TOTAL KNEE ARTHROPLASTY > YOUNG ADULT PROXIMAL FEMUR INJURIES.

[103] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy and Biomechanics, Evaluation, Clinical Examination, and Imaging of the Hip > Imaging.

[105] Classifications in Brief: Garden Classification of Femoral Neck Fractures. Clinical Orthopaedics & Related Research. 2018. DOI: 10.1007/s11999.0000000000000066

[106] Chin-on-Chest in Neck of Femur Fracture (COCNOF) sign: A simple radiographic predictor of frailty and mortality in hip fracture patients. Injury. 2021. DOI: 10.1016/j.injury.2020.10.098

[108] Factors predicting secondary displacement after non-operative treatment of undisplaced femoral neck fractures. Archives of Orthopaedic and Trauma Surgery. 2014. DOI: 10.1007/s00402-014-2139-9

[109] Orthopaedic Knowledge Update Sports Medicine 6. Imaging of the Hip > Summary.

[110] Aaos Comprehensive Orthopaedic Review 3. Musculoskeletal Imaging* > IV. Ultrasonography.

[111] Comparison of dynamic compression system versus multiple cancellous screws in the treatment of femoral neck fractures in young adults. Journal of Orthopaedic Surgery and Research. 2024. DOI: 10.1186/s13018-024-04913-7

[113] Campbell S Operative Orthopaedics 4 Volume Set. OPEN REDUCTION AND INTERNAL FIXATION OF BICONDYLAR INJURIES > DIAGNOSIS.

[116] Exploring the displacement characteristics of Garden III femoral neck fractures and the reliability, validity, and value of the anteroposterior Garden Index in assessing displacement severity. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-023-04269-4

[117] Rockwood And Green S Fractures In Adults. 9: Principles of Nonoperative Management of Fractures > Proximal Femoral Fractures.

[118] Analysis of risk factors for complications after femoral neck fracture in pediatric patients. Journal of Orthopaedic Surgery and Research. 2020. DOI: 10.1186/s13018-020-01587-9

[122] Femoral neck system versus cannulated screws combined with medial plate for femoral neck fractures in young and middle-aged patients: a prospective multicenter randomized controlled trial. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-05972-0

[123] The reliability of a simplified Garden classification for intracapsular hip fractures. Orthopaedics & Traumatology: Surgery & Research. 2012. DOI: 10.1016/j.otsr.2012.02.003

[125] Fibula allograft with cannulated screw fixation versus ordinary cannulated screw fixation for femoral neck fractures: a 10-year retrospective comparative study. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-023-04002-1

[127] Total hip arthroplasty for failed internal fixation of femoral neck fracture: a retrospective study with 2–14 years’ follow-up of 345 patients. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-023-03827-0

[128] Comparison of femoral neck shortening and outcomes between in situ fixation and fixation after reduction for severe valgus-impacted femoral neck fractures. Injury. 2021. DOI: 10.1016/j.injury.2020.10.028

[129] The effect of osteoarthritis on functional outcome following hemiarthroplasty for femoral neck fracture: a prospective observational study. BMC Musculoskeletal Disorders. 2015. DOI: 10.1186/s12891-015-0767-z

[130] Complications of implant removal after healed hip fractures. Archives of Orthopaedic and Trauma Surgery. 2020. DOI: 10.1007/s00402-020-03435-1

[131] Femoral neck fractures in non-geriatric patients: femoral neck system versus cannulated cancellous screw. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-023-06140-3

[132] Cemented Bipolar Hemiarthroplasty Provides Definitive Treatment for Femoral Neck Fractures at 20 Years and Beyond. Clinical Orthopaedics & Related Research. 2015. DOI: 10.1007/s11999-015-4462-z

[133] Clinical value and risk factors of compression supporting screwsin patients with femoral neck fractures. Journal of Orthopaedic Surgery and Research. 2024. DOI: 10.1186/s13018-024-04873-y

[134] Valgus intertrochanteric osteotomy and fibular strut graft in the management of neglected femoral neck fracture. Injury. 2013. DOI: 10.1016/j.injury.2012.09.014

[135] Single Stage Hemiarthroplasty Bipolar Surgical Procedure in 1 year Neglected Femoral Neck Fracture with 4cm Limb Shortening: A Case Report. Orthopaedic Journal of Sports Medicine. 2020. DOI: 10.1177/2325967120s00056

[137] The non-operative treatment of impacted femoral neck fractures. Injury. 2002. DOI: 10.1016/s0020-1383(02)00325-x

[139] Biomechanical rationale for implant choices in femoral neck fracture fixation in the non-elderly. Injury. 2015. DOI: 10.1016/j.injury.2014.12.031

[141] What Are the Differences in Hospital Cost Associated With the Use of Cemented Versus Cementless Femoral Stems in Hemiarthroplasty and Total Hip Arthroplasty for the Treatment of Femoral Neck Fracture?. The Journal of Arthroplasty. 2024. DOI: 10.1016/j.arth.2023.08.017

[142] Outcomes of Cemented versus Cementless Total Hip Arthroplasty Following Displaced Femoral Neck Fracture in Patients Under 65 Years of Age. The Journal of Arthroplasty. 2026. DOI: 10.1016/j.arth.2025.07.013

[143] Ipsilateral femoral neck and shaft fractures. When do we need further image screening of the hip?. Injury. 2021. DOI: 10.1016/j.injury.2021.01.040

[144] Management of young femoral neck fractures: Is there a consensus?. Injury. 2015. DOI: 10.1016/j.injury.2014.11.028

[152] Internal Fixation of Femoral Neck Fractures. Journal of the American Academy of Orthopaedic Surgeons. 2006. DOI: 10.5435/00124635-200609000-00006

[160] A systematic review of undisplaced femoral neck fracture treatments for patients over 65 years of age, with a focus on union rates and avascular necrosis. Journal of Orthopaedic Surgery and Research. 2017. DOI: 10.1186/s13018-017-0528-9

[161] Outcomes of elderly patients with nondisplaced or minimally displaced femoral neck fractures treated with internal fixation: A systematic review and meta-analysis. Injury. 2019. DOI: 10.1016/j.injury.2019.09.039

[167] Conservative management of bilateral femoral neck fractures in a child with autosomal dominant osteopetrosis. Archives of Orthopaedic and Trauma Surgery. 2007. DOI: 10.1007/s00402-007-0392-x

[171] Inferior calcar buttress reduction pattern for displaced femoral neck fractures in young adults: a preliminary report and an effective alternative. Journal of Orthopaedic Surgery and Research. 2019. DOI: 10.1186/s13018-019-1109-x

[173] Sequential scintigraphy and orthoradiographic measurement of femoral shortening after femoral neck fracture. Archives of Orthopaedic and Trauma Surgery. 1997. DOI: 10.1007/bf00393709

[175] The reliability of a Garden, AO and simple II stage classifications for intracapsular hip fractures. Orthopaedics & Traumatology: Surgery & Research. 2019. DOI: 10.1016/j.otsr.2018.11.007

[176] Accuracy of valgus osteotomy using dynamic hip screw. Injury. 2017. DOI: 10.1016/s0020-1383(17)30486-2

[177] Femoral neck fracture: a complication of femoral nailing. Injury. 1996. DOI: 10.1016/0020-1383(96)89813-5

[189] Using a modified Pauwels method to predict the outcome of femoral neck fracture in relatively young patients. Injury. 2015. DOI: 10.1016/j.injury.2015.06.016

[190] Open reduction and internal fixation of irreducible displaced femoral neck fracture with femoral Neck System: a preliminary study. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-023-06839-3

[194] Computed Tomography Overestimates Roentgenographic Posterior Tilt in Geriatric Garden I/II Femoral Neck Fractures. Journal of the American Academy of Orthopaedic Surgeons. 2026. DOI: 10.5435/jaaos-d-25-00669

[196] The sensitivity of ct scans in diagnosing occult femoral neck fractures. Injury. 2016. DOI: 10.1016/j.injury.2016.10.019

[197] Clinical application of modified hip joint lateral position in femoral neck fracture. Journal of Orthopaedic Surgery and Research. 2023. DOI: 10.1186/s13018-023-04183-9

[205] Interpreting preoperative radiographs in displaced femoral neck fractures: observer variability in evaluating signs of poor outcome. Archives of Orthopaedic and Trauma Surgery. 2007. DOI: 10.1007/s00402-006-0276-5

[213] Objective sound wave amplitude measurement generated by a tuning fork. An analysis of its use as a diagnostic tool in suspected femoral neck fractures. Injury. 2012. DOI: 10.1016/j.injury.2011.09.030

[215] Prevention of Unplanned Surgery Due to Delayed Diagnosis of Occult Ipsilateral Femoral Neck Fractures Associated with Femoral Shaft Fractures. Journal of Bone and Joint Surgery. 2021. DOI: 10.2106/jbjs.20.02033

[217] Posterior multifragmentation of the femoral neck: Does it portend a poor outcome in internally fixed intracapsular hip fractures?. Injury. 2009. DOI: 10.1016/j.injury.2008.08.008

[219] Predictive value of early scintimetry in intracapsular hip fractures. Archives of Orthopaedic and Trauma Surgery. 1993. DOI: 10.1007/bf00440592

[220] Treatment of femoral neck fractures in Hungary with the Manninger screw. Injury. 2002. DOI: 10.1016/s0020-1383(02)00327-3

[221] Factors affecting postoperative mortality of patients with displaced femoral neck fracture. Injury. 2006. DOI: 10.1016/j.injury.2006.02.046

[222] The utility of post-operative hip radiographs in patients treated with hip hemiarthroplasty for femoral neck fractures. Injury. 2019. DOI: 10.1016/j.injury.2019.07.005