• Tenuous blood supply → risk of avascular necrosis
• High nonunion rate if fixed in elderly

Management Opions

• OPIF - Open Reduction Internal Fixation

  • Candidates:
    • Non-displaced
    • Mildly or moderately displaced in Young Pt (not fragility fracture)
  • Complications

• Hip Replacement (arthroplasty)

  • Candidates:
    • Elderly (displaced and even non-displaced)
  1. Hemianthroplasty : only femur head
     1. Non-active
  2. Total Hip Anthroplasty : femur head + acetabulum -> better LT outcome
     1. Active
     2. Pre-existing arthritis

Decision Process Summary

Decision based on:

1. Initial displacement – “blood supply” : Internal Fixation vs Replacement
   1. No displacement = IF
   2. Displacement = Replacement
2. Age of the Patient
   1. Young = more likely to IF
   2. Old = more likely to Replacement
3. Demand of activity: Hemi vs total
   1. Low demand = hemi
   2. High demand = total

Grey zone:

• Young + Displaced: technical decision based on surgeon experience
  • OPIF - Open Reduction Internal Fixation
  • Total Hip Anthroplasty
• Old + not displaced: weigh the risks of both procedure
  • OPIF - Open Reduction Internal Fixation
  • Hemianthroplasty (definitive, no AVN risk)