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Peer-reviewedCC BYSICOT-J

Ballistic femoral neck fractures: Current concepts in evaluation and management.

  • Mohamed I Abulsoud1
  • Muhammad Atif2
  • Mohamed H Abdou3
  • Mahmoud M Hassaan4
  • Zenat Khired4
4 affiliations
  1. 1Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt - Department of Orthopedic Surgery, King Khalid Hospital, Najran, Saudi Arabia.
  2. 2Department of Orthopedic Surgery, King Khalid Hospital, Najran, Saudi Arabia.
  3. 3Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
  4. 4Orthopaedic Division, Department of Surgery, College of Medicine, Jazan University, Jazan, Saudi Arabia.
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Abstract

Ballistic femoral neck fractures are complex, high-energy injuries that require a management approach distinct from conventional blunt trauma. These current concepts review examines the evolving landscape of evaluation and treatment for these rare injuries based on contemporary literature. Initial management emphasizes the Advanced Trauma Life Support (ATLS) protocol, with a critical focus on identifying associated neurovascular and skeletal injuries, which are present in approximately one-third of cases. Diagnostic evaluation relies on plain radiography and thin-slice CT to delineate fracture morphology and bullet trajectory, with CT angiography recommended if vascular compromise is suspected. Surgical decision-making balances the goals of head preservation through open reduction and internal fixation (ORIF) against the definitive stability provided by total hip arthroplasty (THA). While ORIF remains the standard for young, active patients, clinicians must account for the historically high incidence of nonunion and infection associated with ballistic mechanisms. In cases of failed osteosynthesis or catastrophic articular comminution, conversion to THA offers a reliable salvage option with favorable functional outcomes. This review highlights the need for individualized treatment plans and meticulous clinical follow-up to manage the inherent risks of this challenging injury pattern.

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Cite

BibTeXRIS
BibTeX
@article{abulsoud2026ballistic,
  title = {{Ballistic femoral neck fractures: Current concepts in evaluation and management.}},
  author = {Mohamed I Abulsoud and Muhammad Atif and Mohamed H Abdou and Mahmoud M Hassaan and Zenat Khired},
  journal = {SICOT-J},
  year = {2026},
  month = oct,
  doi = {10.1051/sicotj/2026084},
  url = {https://europepmc.org/article/MED/42913483},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Ballistic femoral neck fractures: Current concepts in evaluation and management.
AU  - Mohamed I Abulsoud
AU  - Muhammad Atif
AU  - Mohamed H Abdou
AU  - Mahmoud M Hassaan
AU  - Zenat Khired
PY  - 2026
DA  - 2026/10/23
JO  - SICOT-J
DO  - 10.1051/sicotj/2026084
UR  - https://europepmc.org/article/MED/42913483
AB  - Ballistic femoral neck fractures are complex, high-energy injuries that require a management approach distinct from conventional blunt trauma. These current concepts review examines the evolving landscape of evaluation and treatment for these rare injuries based on contemporary literature. Initial management emphasizes the Advanced Trauma Life Support (ATLS) protocol, with a critical focus on identifying associated neurovascular and skeletal injuries, which are present in approximately one-third of cases. Diagnostic evaluation relies on plain radiography and thin-slice CT to delineate fracture morphology and bullet trajectory, with CT angiography recommended if vascular compromise is suspected. Surgical decision-making balances the goals of head preservation through open reduction and internal fixation (ORIF) against the definitive stability provided by total hip arthroplasty (THA). While ORIF remains the standard for young, active patients, clinicians must account for the historically high incidence of nonunion and infection associated with ballistic mechanisms. In cases of failed osteosynthesis or catastrophic articular comminution, conversion to THA offers a reliable salvage option with favorable functional outcomes. This review highlights the need for individualized treatment plans and meticulous clinical follow-up to manage the inherent risks of this challenging injury pattern.
SN  - 2426-8887
ER  -