Neck Fractures In Patients Research Articles

Uni- and bipolar hemiarthroplasty with a modern cemented femoral component provides elderly patients with displaced femoral neck fractures with equal functional outcome and survivorship at medium-term follow-up.

The choice between unipolar and bipolar hemiarthroplasty for treatment of displaced intracapsular femoral neck fractures in elderly patients still remains controversial. Our objective was to compare series of elderly individuals with a displaced femoral neck fracture treated with either a cemented, modular unipolar or bipolar prosthesis with the same femoral component. A prospective, randomized controlled trial of 175 displaced intracapsular femoral neck fractures in patients over 65 years was randomly allocated to unipolar (88) and to bipolar (87) hemiarthroplasty group. The primary end point was implant survival. Secondary end points included difference in ambulatory ability and mortality. Follow-up evaluations were performed at 2 months, at 1, 3 and 5 years. Implant and patient survival were followed until 2/2012. Survival analyses were performed using Kaplan-Meier curves with log-rank test. Data were analyzed using Chi-square test and Student's t test. Unipolar hemiarthroplasty group had a significantly higher dislocation rate when compared with bipolar hemiarthroplasty group. This did not translate into difference in revision rates at 8 years. Prosthetic survival ship was 0.98 (95% Cl 0.94-1.00) in the unipolar group and 0.97 (95% Cl 0.93-1.00) in the bipolar group. There were no statistically significant differences in ambulatory ability, possibility to return home mortality or early radiological acetabular erosion. There were significantly more one-time dislocations in the unipolar group, but there was no difference in incidence of revisions due to recurrent dislocations. The overall mortality rate was 6% at 30 days, 9% at 90 days, 16% at 12 months, and 53% at 5 years. There was no difference in mortality between the groups. Unipolar hemiarthroplasty group had a significantly higher dislocation rate when compared with bipolar hemiarthroplasty group. However, both provide elderly patients with equal ambulatory ability and low revision rate at medium-term follow-up.

Concern About Femoral Neck Fractures in Long-Necked Modular Implants.

As outlined in our January 16, 2013 editorial, “The Case Report Redefined with JBJS Case Connector ,” one important role of JBJS Case Connector is to alert the orthopaedic community about a potentially problematic device or therapy. When two or more such cases with similar mechanisms appear, we will identify the procedure or implant as a “watchable” intervention. While this system is not statistically conclusive and may or may not be supported by other published case reports or registry data, the intention is to sharpen the focus of clinicians on the potential for similar problems and thereby enhance clinical outcomes and patient safety. The “Watch” designation may also encourage others to report related difficulties and enlist the orthopaedic community to either demonstrate that these are isolated, unrelated cases or sharpen the focus further on rigorously evaluating the intervention. Where appropriate, we may identify brand, model, or implant-lot specifics. Modularity in the heads and stems of total hip prostheses has afforded orthopaedic surgeons the ability to intraoperatively adjust version, limb length, and offset in ways that can optimize hip biomechanics. Modular implants have achieved these important objectives in thousands of patients over the last couple of decades. However, the rewards of modularity come with risks—some of them serious. Reports of these risks seem to have become more prevalent in the recent orthopaedic literature. In this “Watch,” we bring to the attention of the orthopaedic community several femoral neck fractures in patients with implants that had modular head-neck and neck-stem designs. While some of these designs are no longer available from manufacturers, thousands of such devices have already been implanted. This “Watch” encourages surgeons to be wary about one specific aspect of modular hip designs: long femoral necks. One of the weakest points in any hip prosthesis is the femoral neck. This …

The Result of In Situ Pinning for Valgus Impacted Femoral Neck Fractures of Patients over 70 Years Old.

PurposeWe aimed to evaluate the outcome of fixation with cannulated screws for valgus impacted femoral neck fractures in patients over 70 years of age.Materials and MethodsWe reviewed the outcome in 33 patients older than 70 years with valgus impacted femoral neck fractures who were treated with cannulated screws fixation from May 2007 to December 2010. These patients were followed for at least a year. We assessed the fixation failure rate, body mass index (BMI), bone mineral density (BMD) of proximal femur, distance between screw tip and joint, number of screws and time from fracture to operation.ResultsWe identified six patients (18.2%) with failure. Two patients with subtrochanteric fractures through the screw insertion site and another patient with osteonecrosis were excluded from the fixation failure group. No difference was found in age, BMI, BMD of proximal femur, distance between screw tip and joint, number of screws and time from fracture to operation between failure and non-failure groups.ConclusionThe failure rate of cannualted screw fixation for valgus impacted femoral neck fractures in the elderly patients was not low. Risk of failure should be considered in the management of these patients and accurate assessment for fracture type should be performed using computed tomogram and clinical evaluation.

Early Results after Treatment of Femoral Neck Fractures with Total Hip Arthroplasty Using Cementless Fiber Metal Taper® Stem in Elderly Patients

Purpose: The purpose of this study was to evaluate the early results of clinicoradiological outcomes after cementless total hip arthroplasty (THA) for displaced femoral neck fracture in elderly patients. Materials and Methods: A total of 44 cementless THA procedures performed between January 2008 and January 2012 for displaced femoral neck fracture in patients older than 65 years of age were enrolled in this study and all patients presented normal cognitive ability preoperatively and were followed for more than two years after surgery. We evaluate the clinical and radiological results. The mean age was 72 years (range 65−81 years), 34 patients were female, and 10 patients were male. The mean follow-up period was 30.7 months. Results: Clinically, at the last follow-up, the mean Harris hip score was 96.5 points. Walking ability was recovered postoperatively in 79.5% of cases (35 cases), and activities of daily living were achieved in 66% of cases (29 cases). Radiographically, none of the acetabular cups showed evidence of migration, loosening, or osteolysis. All cases showed excellent or good fixation postoperatively and stable bony fixation of the femoral stem, with the exception of one case, who presented with a periprosthetic fracture during follow-up. There were no cases of osteolysis, significant alignment change or progressive subsidence. Postoperative dislocation occurred in two cases (4.5%), but no re-dislocations were observed after closed reduction. Conclusion: Short-term outcomes proved to be satisfactory in elderly patients older than 65 years of age, who presented with normal cognitive ability preoperatively, undergoing cementless THA for displaced femoral neck fractures.

Internal Fixation Versus Cemented Hemiarthroplasty for Displaced Femoral Neck Fractures in Patients With Severe Cognitive Dysfunction

To compare the outcome of internal fixation (IF) versus a cemented hemiarthroplasty (HA) in patients with a displaced femoral neck fracture and a severe cognitive dysfunction. A prospective randomized controlled trial. A tertiary care university hospital. Sixty patients with a displaced femoral neck fracture were randomized to IF (n = 30) or HA (n = 30). All patients suffered from severe cognitive dysfunction but were able to walk before the fracture. IF using 2 cannulated screws or HA using a cemented Exeter unipolar arthroplasty. Patients were reviewed at 4, 12, and 24 months after the fracture. Outcome assessments included complications, reoperations, hip function (Charnley score), and health-related quality of life (EQ-5Dindex score). A total of 8 patients were reoperated (14%); 7 in the IF group and 1 in the HA group. The EQ-5Dindex score at the follow-ups were generally lower in the IF group compared with the HA group with a significant difference at 12 months (P = 0.03). No difference was seen in hip function, general complications, or mortality between the groups. HA seems to provide a safe option with better health-related quality of life and less risk for reoperations compared with IF for these patients. Therapeutic level II.

CORR Insights®: Association of a Modified Frailty Index with Mortality After Femoral Neck Fracture in Patients Aged 60 Years and Older

CORR Insights®: Association of a Modified Frailty Index with Mortality After Femoral Neck Fracture in Patients Aged 60 Years and Older

The effect of renal function on surgical outcomes of intracapsular hip fractures with osteosynthesis

Chronic kidney disease (CKD) affects many physiologic systems, including bone quality, nutrition, and cardiovascular condition. Femoral neck fractures in patients on dialysis are associated with frequent complications and a high risk of mortality. However, the effect of CKD on clinical outcomes of patients with hip fractures treated with osteosynthesis remains unclear. One hundred and thirty patients with 130 femoral neck fractures treated with internal fixation were divided into two groups and the data were then analyzed. Group 1 consisted of 98 patients (98 hip fractures) with normal renal function (estimated glomerular filtration rate, or eGFR, ≥60 ml/min/1.73 m(2)). Group 2 was composed of 32 patients (32 hip fractures) with CKD (eGFR <60 ml/min/1.73 m(2)) without dialysis. Clinical outcomes as well as early and late complications were recorded for each group. Survivorship analysis was performed, and the mortality and complication rates for the groups were then compared. In Group 1, 32 complications (32.6%) occurred in 98 hips, including 5 cases of nonunion and 16 cases of osteonecrosis. In Group 2, 24 complications (75%) developed in 32 hips; these included 8 cases of nonunion and 3 cases of osteonecrosis. The mean duration of follow-up was 32 months. The overall mortality rate was 11.5%. No difference was noted in early, late, or overall mortality rate between two groups. Patient with CKD had a higher nonunion rate (OR = 5.9, P = 0.023). Meanwhile, CKD and displaced fracture pattern were independent predictors for revision surgery (OR = 3.0, P = 0.032; OR = 6.9, P = 0.001, respectively). Osteosynthesis is a safe and effective treatment for femoral neck fractures; however, patients with femoral neck fracture and CKD have a higher risk of nonunion and subsequent surgical revision. Prognostic studies, Level III.

Association of a Modified Frailty Index With Mortality After Femoral Neck Fracture in Patients Aged 60 Years and Older

Frailty, a multidimensional syndrome entailing loss of energy, physical ability, cognition, and health, plays a significant role in elderly morbidity and mortality. No study has examined frailty in relation to mortality after femoral neck fractures in elderly patients. We examined the association of a modified frailty index abbreviated from the Canadian Study of Health and Aging Frailty Index to 1- and 2-year mortality rates after a femoral neck fracture. Specifically we examined: (1) Is there an association of a modified frailty index with 1- and 2-year mortality rates in patients aged 60 years and older who sustain a low-energy femoral neck fracture? (2) Do the receiver operating characteristic (ROC) curves indicate that the modified frailty index can be a potential tool predictive of mortality and does a specific modified frailty index value demonstrate increased odds ratio for mortality? (3) Do any of the individual clinical deficits comprising the modified frailty index independently associate with mortality? We retrospectively reviewed 697 low-energy femoral neck fractures in patients aged 60 years and older at our Level I trauma center from 2005 to 2009. A total of 218 (31%) patients with high-energy or pathologic fracture, postoperative complication including infection or revision surgery, fracture of the contralateral hip, or missing documented mobility status were excluded. The remaining 481 patients, with a mean age of 81.2 years, were included. Mortality data were obtained from a state vital statistics department using date of birth and Social Security numbers. Statistical analysis included unequal variance t-test, Pearson correlation of age and frailty, ROC curves and area under the curve, Hosmer-Lemeshow statistics, and logistic regression models. One-year mortality analysis found the mean modified frailty index was higher in patients who died (4.6 ± 1.8) than in those who lived (3.0 ± 2; p < 0.001), which was maintained in a 2-year mortality analysis (4.4 ± 1.8 versus 3.0 ± 2; p < 0.001). In ROC analysis, the area under the curve was 0.74 and 0.72 for 1- and 2-year mortality, respectively. Patients with a modified frailty index of 4 or greater had an odds ratio of 4.97 for 1-year mortality and an odds ratio of 4.01 for 2-year mortality as compared with patients with less than 4. Logistic regression models demonstrated that the clinical deficits of mobility, respiratory, renal, malignancy, thyroid, and impaired cognition were independently associated with 1- and 2-year mortality. Patients aged 60 years and older sustaining a femoral neck fracture, with a higher modified frailty index, had increased 1- and 2-year mortality rates, and the ROC analysis suggests that this tool may be predictive of mortality. Patients with a modified frailty index of 4 or greater have increased risk for mortality at 1 and 2 years. Clinical deficits of mobility, respiratory, renal, malignancy, thyroid, and impaired cognition also may be independently associated with mortality. The modified frailty index may be a useful tool in predicting mortality, guiding patient and family expectations and elucidating implant/surgery choices. Further prospective studies are necessary to strengthen the predictive power of the index. Level IV, prognostic study. See Instructions for Authors for a complete description of levels of evidence.

Assessment of time factor in managing femoral neck fractures by internal fixation in patients above 55 years of age

Background Intracapsular hip fractures account for approximately half of all hip fractures. Present treatment of an intracapsular fracture entails either replacement arthroplasty or preservation of the femoral head. In old age patients, the decision between fixation and arthroplasty becomes an issue: Although fixation is a biological solution for this fracture treatment, it has a high nonunion rate with a long postoperative recumbency period and its known complications; in contrast, arthroplasty has its advantage in early mobilization of the patient but has its well-known complications, starting with infection and ending with loosening and the need for revisions. Evidence from the literature on the effect of timing of fixation on outcomes after femoral neck fractures is conflicting. The purpose of this study was to analyze the effect of timing of surgery on the incidence of nonunion and avascular necrosis (AVN) after internal fixation of femoral neck fractures in patients above the age of 55 years. Patients and methods This study included 30 patients (13 men and 17 women) between 56–77 years of age (average 65.1 years) with femoral neck fractures who were treated by closed reduction and internal fixation and were followed up for a minimum of period of 2 years. Nineteen patients (63.33%) had displaced fractures. The average time lag between injury and surgery was 37.5 h (6–144). The patients were divided into two groups: 12 patients (40%) were treated within 12 h after injury (early fixation group) and 18 (60%) were treated more than 12 h after injury (late fixation group). All patients were treated by closed reduction and multiple screw fixation. Results The average age of the patients in the early fixation group (12 patients) was 61.9 years and that of patients in the late fixation group (18 patients) was 67.7 years. There were seven women in the early fixation group and 10 in the late fixation group. There were eight cases of displaced fractures (66.67%) in the early fixation group and 11 cases (61.1%) of the same in the late fixation group. The average time lag between injury and fixation was 10.5 h in the early fixation group and 54.78 h in the late fixation group. All fractures united within an average period of 86.8 days (range 60–128). The final results were satisfactory in 22 hips (73.33%) and unsatisfactory in eight hips (26.67%). No statistically significant difference was found in the duration of fracture union and AVN with regard to sex distribution and mechanism of injury. Variables affecting the final results of treatment were: the time factor, age at surgery and type of fracture. Conclusion Closed reduction and internal fixation is a valid contribution to the treatment of femoral neck fractures in patients above 55 years of age (56–65). The rate of nonunion and AVN was affected by a delay of more than 12 h before fixation for femoral neck fractures in this age group. The incidence of failure was significantly higher in patients aged 65 years or above and in cases of displaced fractures.

SAT0344 Does proximal femur shape contribute to femoral neck fracture risk in osteoporotic individuals?

BackgroundHip Structural Analysis (HSA) has been used to investigate the relationship between proximal femoral neck shape and femoral neck fracture risk; studies have reported contrasting findings. Although previous work has...

Four quadrant parallel peripheral screw fixation for displaced femoral neck fractures in elderly patients

Background:The treatment options for displaced femoral neck fracture in elderly are screw fixation, hemiarthroplasty and total hip arthroplasty based primarily on age of the patient. The issues in screw fixation are ideal patient selection, optimal number of screws, optimal screw configuration and positioning inside the head and neck of femur. The problems of screw fixation may be loss of fixation, joint penetration, avascular necrosis of femoral head, nonunion, prolonged rehabilitation period and the need for second surgery in failed cases. We hereby present results of a modified screw fixation technique in femoral neck fractures in patients ≥50 years of age.Materials and Methods:Patients ≥50 years of age (range 50-73 years) who sustained displaced femoral neck fracture and fulfilled the inclusion criteria were enrolled in this prospective study. They were treated with closed reduction under image intensifier control and cannulated cancellous screw fixation. Accurate anatomical reduction was not aimed and a cross sectional contact area of >75% without varus was accepted as good reduction. Four screws were positioned in four quadrants of femoral head and neck, as parallel and as peripheral as possible. Radiological and functional results were evaluated periodically. Sixty four patients who could complete a minimum followup of two years were analyzed.Results:Radiologically, all fractures healed after mean duration of 10 weeks (range 8-12 weeks). There was no avascular necrosis. Nonanatomical healing was observed in 45 cases (70%). All patients except one had excellent functional outcome and could do cross-legged sitting and squatting. Chondrolysis with progressive head resorption was seen in one case, which was converted to total hip arthroplasty.Conclusion:Closed reduction and cannulated cancellous screw fixation gives satisfactory functional results in large group of elderly patients. The four quadrant parallel peripheral (FQPP) screw fixation technique gives good stability, allows controlled collapse, avoids fixation failure and achieves predictable bone healing in displaced femoral neck fracture in patients ≥50 years of age.

Surgical treatment of hemodialysis patients after femoral neck fracture

The aim of this paper is to show our results in the treatment of femur neck fractures in patients on hemodialysis. The femur neck fractures are more common in patients on hemodialysis than in patients without chronic renal failure. From the year 2000. to 2012, in the Traumatologic center of the CHC Zemun, 12 patients in terminal renal failure with femur neck fractures, were treated. The postoperative rehabilitation, occurence of complications and survival rates were followed. The operative treatment of femur neck fractures by implantation of endoprosthesis in patients with chronic renal failure, although followed by frequent complications, gives the patient a chance to return to normal activity.

Surgical treatment of femoral neck fractures in patients with rheumatoid arthritis

Surgical treatment of femoral neck fractures in patients with rheumatoid arthritis

Time to internal fixation of femoral neck fractures in patients under sixty years—does this matter in the development of osteonecrosis of femoral head?

Osteonecrosis of femoral head remains a major complication of femoral neck fractures. It has been postulated that early internal fixation drastically reduces the incidence of osteonecrosis of the femoral head. However, there is a paucity of literature looking at the effect of time delay to internal fixation on the development of this late complication. In this study, we aim to assess the effect of time delay and method of internal fixation on the development of osteonecrosis in those less than 60 years of age. We retrospectively analysed 92 patients less than 60 years of age who presented with intracapsular neck of femur fractures that underwent internal fixation between 1999 and 2009. Of the 92 intracapsular fractures, 50 underwent fixation using cannulated screws, 32 using a dynamic hip screw, and ten using a dynamic hip screw with a derotation screw. In total, 13 patients (14.1 %) developed osteonecrosis of the femoral head, the highest incidence being in the cannulated screw fixation group with an osteonecrosis rate of 24 %. We did not find the time delay to internal fixation to be a significant predictor of the development of osteonecrosis. Our study demonstrated that the method of internal fixation rather than delay in internal fixation was more predictive of osteonecrosis of the femoral head. We did not find support to the current belief that early surgical fixation of neck of femur fractures reduces the risk of osteonecrosis in patients less than 60 years.

Predictors of Femoral Neck Fracture Following Hip Resurfacing: A Cadaveric Study

We aimed to establish if radiological parameters, dual energy x-ray absorptiometry (DEXA) and quantitative CT (qCT) could predict the risk of sustaining a femoral neck fracture following hip resurfacing. Twenty-one unilateral fresh frozen femurs were used. Each femur had a plain digital anteroposterior radiograph, DEXA scan and qCT scan. Femurs were then prepared for a Birmingham Hip Resurfacing femoral component and loaded to failure. Results demonstrated that gender and qCT measurements showed strong correlation with failure load. QCT could be used as an individual measure to predict risk of post-operative femoral neck fracture. However, when qCT is unavailable; gender, pre-operative DEXA scan and Neck Width measurements can be used together to assess risk of post-operative femoral neck fracture in patients due to undergo hip resurfacing.

Neglected femoral neck fracture in patient with seizure: a case of a delayed fixation of type 1A fracture in 11-month-old infant.

Fractures of the hip are rare injuries in children, accounting for less than 1% of all pediatric fractures. Compared with other pediatric skeletal injuries, hip fractures are associated with high complication rates and poor outcomes, most commonly osteonecrosis, as well as non-union and malunion. Although significant trauma is the most common reason of the separation of upper femoral epiphysis, furthermore some cases were reported after seizures. To our knowledge, there is no previous publication in the literature that reports the results of delayed reduction and fixation of transepiphyseal separation of the proximal femoral epiphysis. We report a case of delayed open reduction and internal fixation of Delbet type 1A femoral neck fracture following seizures in an 11-month-old male child.

Femoral neck fracture in end-stage renal disease treated with osteosynthesis

BackgroundTreatment of femoral neck fracture is well documented in the literature. Femoral neck fractures in patients aged < 65 years are generally treated using closed reduction and internal fixation, while hemiarthroplasty is the treatment of choice for patients > 65 years. In specific populations, such as patients with end-stage renal disease (ESRD), this protocol is usually observed. However, unsatisfactory results and a large number of complications have been reported. It is questionable whether this protocol is the appropriate treatment and it may require modification for use in ESRD patients. Materials and methodsThe results of this study are in regard to the treatment of a consecutive series of 20 patients with femoral neck fractures and ESRD over a 7-year period. All of the patients were treated using closed reduction and internal fixation. ResultsEight of 13 (61.5%) patients developed nonunion (of which 5 were classified as displaced fractures). Six of these eight patients were subsequently treated with hemiarthroplasty (75%). Five of these 13 patients(38.4%) achieved union; all of these were classified as nondisplaced fractures. In patients < 70 years, five of 11 patients demonstrated nonunion (45.5%), of which all were classified as displaced fractures. The mortality rate of this series was 33.3% (5 of 15 patients). ConclusionWe determined that a femoral neck fracture in an ESRD patient is a unique case and should be treated differently from general treatment protocols. It is suggested that regardless of patient age,nondisplaced fractures should be treated with osteosynthesis, while hemiarthroplasty is a better treatment for displaced fractures.

The development of a decision aid to elicit treatment preferences for displaced femoral neck fractures

Background:Decision aids help physicians convey information to patients and enable patients to be involved in the decision-making process. There is a lack of use of decision aids in the orthopedic literature. The purpose of this study was to develop a decision board to elicit preferences for treatment of displaced femoral neck fractures in patients over 60 years old.Materials and Methods:We developed a decision board presenting descriptions and potential outcomes and complications of two treatment options, hemiarthroplasty (HA) and internal fixation (IF), for displaced femoral neck fractures. Five orthopedic surgeons evaluated the face and content validity of the decision board and 10 volunteers completed “scope tests” to determine the comprehensibility. We then presented the decision board to 108 study participants faced with the scenario of sustaining a displaced femoral neck fracture. Participants stated their preference for operative procedure and described the reasons for their choices.Results:The decision board achieved good face and content validity. All participants in the scope tests appropriately switched their preference to the other modality when probabilities were altered. Most participants found the decision board easy to understand and helpful in making an informed decision. Also, most participants were satisfied with the amount of information presented and with the use of the decision board as a decision making tool. Sixty-one participants (56%) chose IF as their operative procedure of choice quoting less blood loss, shorter operative time, and less invasiveness as the top factors that contributed to this choice. Participants who preferred HA (44%) did so primarily due to the lower re-operation rate.Conclusions:The decision board is a useful and reliable tool to inform patients about the treatment options for displaced femoral neck fractures. They should be utilized by surgeons to incorporate patients’ preferences into the decision-making process.

Is the Dislocation Rate Higher after Bipolar Hemiarthroplasty in Patients with Neuromuscular Diseases?

Patients with neuromuscular disease reportedly have a higher incidence of postoperative dislocation after bipolar hemiarthroplasty. Although the literature has focused on a high prevalence of preoperative neurologic conditions in patients who had dislocations after bipolar hemiarthroplasties, the relative incidence of dislocation in patients with neuromuscular disease and without is unclear. We therefore (1) asked whether the incidence of postoperative dislocation after bipolar hemiarthroplasty was greater in patients with neuromuscular disease than for those without, and (2) whether function differed between the two groups, and (3) explored potential risk factors for dislocation in two groups. We retrospectively reviewed 190 patients who underwent bipolar hemiarthroplasties for fracture of the femoral neck between 1996 and 2008. Of the 190 patients, 42 had various neuromuscular diseases and 148 had no history of neuromuscular disease. Intraoperative stability was tested and posterior soft tissue repair was performed in all patients. We determined the incidence of dislocation, postoperative leg length discrepancy, and femoral offset in patients with or without neuromuscular disease. The incidence of dislocation was 2.6% in all patients. We observed similar rates of dislocation in the two groups: 4.8% (two of 42 hips) in patients with neuromuscular disease and 2.0% (three of 148 hips) in patients without neuromuscular disease. In femoral neck fractures in patients with neuromuscular disease, careful preoperative management and operative technique such as a posterior soft tissue repair might decrease the risk of postoperative dislocation; therefore, we consider the bipolar hemiarthroplasty a reasonable treatment option. Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Review of a Single Contemporary Femoral Neck Fracture Fixation Method in Young Patients

An intracapsular femoral neck fracture in a young patient is a rare and difficult injury to manage. The occurrence of complications following fixation is multifactorial. Initial displacement and timing and accuracy of reduction are the key factors affecting outcome. The severities of the trauma to the hip and the impact of the intracapsular hematoma also play a role, the importance of which remains poorly understood. The purpose of this study was to evaluate the high incidence of femoral neck fractures treated in our institution over a 7-month period, to record the long-term outcome of these patients, all of whom were treated with contemporary methods of internal fixation, and to highlight the reasons for this injury being termed an "orthopedic emergency" and its differences from the same injury in the elderly population. We performed a retrospective analysis of 12 cases of intracapsular femur neck fracture in patients younger than 50 years treated over 7 months in a regional trauma center. All patients underwent satisfactory reduction and fixation. Nine of the 12 patients had a good outcome at a mean follow-up of 29 months. One patient developed a nonunion of the femoral head requiring total hip arthroplasty, one developed avascular necrosis of the femoral head, and one developed partial avascular necrosis. This compares favorably with other studies.