• Instr Course Lect · Jan 1984

    Femoral head preservation following subcapital fracture of the femur.

    • J P Waddell.
    • Instr Course Lect. 1984 Jan 1; 33: 179-90.

    AbstractPrimary fixation of displaced subcapital fractures offers a low morbidity and low mortality approach to a very common problem. The vast majority of patients receiving this form of treatment will not require further surgery. When contrasted with the problems of primary arthroplasty which included a higher morbidity and higher mortality, a higher infection rate, and the possibility of prosthetic loosening, prosthetic dislocation, acetabular wear to subsequent pain, and protrusio, the choice seems very clear. We would reserve arthroplasty for the following: Patients with pathologic fractures of the femoral neck secondary to metastatic disease. Patients with displaced fractures of the femoral oral neck who have primary hip disease such as rheumatoid arthritis. Patients with coexistent serious illness with a grossly limited life expectancy. Enfeebled elderly patients with minimal demands (senile, demented, minimal ambulatory or not ambulatory before fracture. (We would not perform primary arthroplasty in patients with neurologic disorder leading to spasticity or contracture, since we found the dislocation rate in such patients to be unacceptably high). In patients under 60 years of age with displaced subcapital fractures of the femoral neck we would advocate the following: Anatomic reduction (open, if necessary); Sound secure fixation; Staged muscle pedicle graft to promote increased fixation and ideally femoral head vascularity; No weight bearing until the fracture unites. In patients greater than 60 years of age we would advocate the following: Anatomic or slight valgus reduction of the fracture; Sound secure fixation; Impaction of the fracture; Weight bearing as tolerated. If these principles are followed, the results of a policy of femoral head preservation in displaced subcapital fractures will be very acceptable for both the patient and surgeon alike. In our opinion, prosthetic replacement equals salvage surgery, and it should be delegated to that role.

      Pubmed     Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…