Managing a fractured neck of the femur in young adults requires a tailored approach, as these injuries are less common in this age group but can be particularly challenging due to the high demands placed on the hip joint and the need for optimal functional recovery. Here's a general overview of how such fractures are managed:

1. Initial Assessment and Diagnosis 

  • Clinical Evaluation: Assess the patient’s history, mechanism of injury, and perform a physical examination. Look for symptoms such as hip pain, inability to bear weight, and abnormal leg positioning.
  • Imaging: Obtain X-rays of the hip and pelvis to determine the fracture type. A CT scan or MRI might be needed for detailed assessment, especially if there's a suspicion of a displaced fracture or poor-quality X-rays.

2. Classification: Fractures of the femoral neck are typically classified using the Garden classification or the AO/OTA classification, which helps guide treatment decisions. They can be classified as:

Garden I & II: Incomplete (Garden I) or complete but non-displaced (Garden II) fractures.

Garden III & IV: Displaced fractures (Garden III is partially displaced, Garden IV is fully displaced)

3. Treatment Options

Non-Surgical Management

  • Indications: Generally reserved for Garden I fractures or non-displaced fractures where surgical options are contraindicated.
  • Treatment: This might involve bed rest, traction, and early mobilization. The patient will need close follow-up to monitor for potential displacement and complications.

Surgical Management

Surgical treatment is typically preferred in young adults to promote early mobility and restore function. 

Options include:

  • Internal Fixation:Hip Screws or Cannulated Screws: Commonly used for stable or non-displaced fractures (Garden I or II).
  • Dynamic Hip Screw (DHS): Useful for some types of fractures, particularly in older patients or those with a more stable fracture pattern.
  • Hip Arthroplasty:
    Hemiarthroplasty: Involves replacing only the femoral head and is generally reserved for older patients or those with poor bone quality.
    Total Hip Arthroplasty (THA): Rarely used in young adults unless there is significant joint damage or complications.
  • Open Reduction and Internal Fixation (ORIF): Used for displaced fractures (Garden III and IV). This procedure aims to realign the fracture and stabilize it with screws, plates, or other fixation devices.


4. Postoperative Care 

  • Rehabilitation: Early mobilization is crucial. Physiotherapy should start as soon as possible to improve range of motion, strength, and gait. Weight-bearing protocols depend on the type of fixation and the fracture pattern.
  • Monitoring: Regular follow-up is essential to assess healing through clinical evaluation and imaging. Watch for complications such as non-union, avascular necrosis, or infection.

5. Long-Term Outcomes

  • Functional Recovery: Most young adults recover well with appropriate treatment. They typically return to their pre-injury levels of activity.
  • Complications: Potential issues include non-union, avascular necrosis of the femoral head, and early arthritis. Long-term follow-up helps manage these risks.

Overall, the goal is to restore hip function and minimize complications, with treatment decisions influenced by the type of fracture, patient’s activity level, and overall health.