The management of intracapsular fractures of the proximal femur

The optimum choice of treatment for an intracapsular fracture cannot be based purely on the radiological appearance of the fracture and on the age of the patient. Although these are the main considerations many other factors need to be evaluated for each individual patient. Figure 1 gives a flow diagram which helps to aid decision in treatment. The intracapsular fracture should not be thought of as the unsolved fracture. Internal fixation is indicated for selected fractures. Some require arthroplasty and for others either treatment can be used. The clinician must assess each of the individual risk factors for healing in each patient, and then decide if the risk of failure of internal fixation is high enough to justify replacing the femoral head with an arthroplasty.