avascular necrosis - develops in 30% of displaced and in 10% of undisplaced fractures. Treatment is total hip replacement irrespective of union as such patients will experience continued pain and progressive loss of function
non-union - develops in one-third of all femoral neck fractures, but especially, in displaced ones. Corrective treatment depends on the patient's age and the type of treatment already received:
younger patients may be considered for subtrochanteric osteotomy - if the head is alive; for a second internal fixation if there is no evidence of necrosis and reduction had originally been faulty; or for a prosthesis if necrosis has developed
older patients should be managed conservatively - by wearing a raised heel and walking with a stick, if the pain is mild; or with total hip replacement if the pain is intolerable and the patient is fit for operation
osteoarthritis - this may occur many years afterward. Total hip replacement should be considered depending on the patients age, discomfort etc.
Reference
NICE. Hip fracture: management. Clinical guideline CG124. Published June 2011, last updated January 2023.
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