Direct anterior approach for femoral neck fractures: Why and how?

Femoral neck fractures are among the most common orthopedic injuries, often managed using closed reduction internal fixation (CRIF), hemiarthroplasty, or total hip arthroplasty (THA). While several approaches have been utilized in the surgical management of femoral neck fractures, the direct anterior approach (DAA) has emerged as a popular approach for hip arthroplasty given its smaller incision, muscle sparing technique, and robust outcomes. Several studies and meta-analyses have demonstrated that the DAA has fewer complications, dislocations, and better early functional outcomes compared to other approaches when performing hip arthroplasty for femoral neck fractures. Furthermore, studies have demonstrated promising outcomes with the utilization of the DAA approach for femoral neck fracture visualization and anatomic reduction, which is particularly important when caring for younger high-energy trauma patients. Given the notable morbidity and mortality associated with geriatric femoral neck fractures in particular, the DAA may be yet another technique that can further reduce the incidence of adverse outcomes seen in this population as we anticipate a rising elderly patient population in the coming years.