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Nowadays, the most important socioeconomic problem is osteoporosis; its incidence increases steadily. The expression and the most severe complication of its senile form is the that contributes considerably to the mortality in due to preexisting diseases and to the complications resulting from confinement to bed.

The anatomic peculiarities of the proximal femur, the intra-as well as the extraarticular location of the femoral head, the vulnerability of the vessels, the anteversion of the neck and the senile regressive changes explain the characteristic and the threatening problems of local complications. Although not belonging directly to the pathology of the fracture, the influences considerably the chances of healing (Ceder et al, 1979; Molnár et al, 1979; Sartonetti et al, 1995). Concomitant diseases and changes that increase in severity and frequency with age are of when deciding on the type of surgery and rehabilitation.

In general, the femoral neck fracture in the elderly results from a single trauma after a . Not infrequently it is accompanied by a fracture of the (distal radius, proximal humerus), often due to osteoporosis. In young persons a neck fracture is usually caused by a major trauma. Typically for an is the preserved or slowly deteriorating ability to walk. The inability to walk may also occur after repeated falls. are characterized by slowly increasing pain after prolonged or sudden overexertion. If the anamnesis reveals no trauma but a known systemic disease, a must be suspected.

The first proper description of proximal femur fractures was done by in the 16th century. Up to this time they were thought to be dislocations (cited by Cordasco, 1938).

In Sects. 1.3 and 1.5, we have discussed the of the proximal femur that determine the optimal position of the stabilizing implants during internal fixation (three-point buttressing: lateral cortex, Adam’s arch/calcar femorale and subchondral bone in the femoral head). In Sect. 4.2.2, we summarized as they are t in respect to the internal fixation with two Smith-Petersen nails. These principles are still valid:

Contrary to the classical orthopedic concepts (“acute abdomen”) and the is of cardinal importance in general surgery. not lost their importance in trauma surgery and are the basis of immediate action. Interventions whether performed or missed during the first hour (“golden hour”), or even during the first 30 minutes determine the survival and later the quality of life of the severely injured person, victims of . Generally accepted is also the priority of .

A meticulous clinical and radiologic examination (analysis of the fracture type), an anatomic reduction, a properly executed internal fixation and a correct rehabilitation (mobilization as early as possible with weight-bearing) are the most important parts for any head-preserving treatment of neck fractures. We are in full agreement with authors who insist on the cardinal role of reduction (Parker and Pryor, 1993). According to . Any error in reduction cannot be (see Figs. 211 and 212). He also made it equally understood that a will always only be a substitution. The current trend points toward a head-preserving intervention as achieved by an internal fixation. Problems nowadays encountered are due to the fact that major parts of the . The younger generation of surgeons has not anymore been exposed to a proper execution of a closed reduction.

To meet the requirements for emergency surgery the preparations should be as succinct as possible. With the exception of evidently absolute contraindications and remote fractures . This includes patients in whom the interval between trauma and admission exceeds six hours. Therefore we divide the patients rather speedily into the following groups: patients that can be operated immediately, patients that need a short preparation, and patients that can only undergo delayed surgery after appropriate medical treatment for conditions such as high blood pressure and dehydration.

Up to the present day, controversial opinions can be found in the literature regarding the treatment of femoral neck fractures either impacted in valgus or without displacement (Garden-I and -II). : centers which favor a primary internal fixation (Scandinavia, Hungary and recently some institutions in USA) chose internal fixation also for undisplaced fractures (Phillips and Christie, 1988; Doran et al, 1989; Nilsson et al, 1989a; Manninger et al, 1990; Sernbo et al, 1990; Parker et al, 1991b; Strömqvist et al, 1992; Kyle et al, 1994). Centers, however, those treat patients older than 60—70 years with displaced neck fractures by an arthroplasty, prefer a approach for undisplaced neck fractures (Riedl et al, 1989; Braun et al, 1991; Raaymakers and Marti, 1991; van Vugt, 1991; Berwarth and Schlickewei, 1992; Hui et al, 1994).

A prerequisite for an uneventful healing is a meticulous postoperative surveillance and care. State of consciousness, blood pressure, heart rate, respiration, fluid intake and output and laboratory tests have to be checked.