Individualised therapy of femoral neck fractures - the Wiesbaden concept

Background: The global incidence of femoral neck fractures is projected to reach 6.2 to 8.2 million cases annually by 2050. While internal fixation remains the standard for younger patients, high rates of avascular necrosis and hardware failure—approaching 40%—have led to an increased utilization of arthroplasty in older populations. Despite national guidelines, significant regional and specialty-based variations persist in surgical decision-making and implant selection.

Objective: This article describes the "Wiesbaden concept," a standardized treatment algorithm for femoral neck fractures designed to optimize implant selection based on patient demographics, bone quality, and functional requirements.

Key Points: The algorithm categorizes patients by age, medical history, and radiographic parameters, including Garden and Pauwels classifications, Dorr femoral morphology, and the cortical ring structure. For patients over 65 years, joint replacement is preferred over osteosynthesis, even for undisplaced fractures. In the authors' series, 57% of patients received total hip arthroplasty (THA) and 37% hemiarthroplasty. While cemented fixation is standard for poor bone quality, cementless short-stem implants are utilized in active patients with Dorr type A or B morphology. Furthermore, dual mobility cups are increasingly employed for patients with high dislocation risk or concomitant osteoarthritis to improve stability and clinical outcomes.

Conclusion: An individualized, multidisciplinary approach incorporating geriatric co-management and a structured surgical algorithm may reduce complications. Preliminary data suggest that cementless short stems and dual mobility components offer viable alternatives to traditional hemiarthroplasty in appropriately selected elderly patients.