Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Jun 2002
ReviewReduction and fixation of displaced intracapsular fractures of the proximal femur.
Intracapsular fractures of the femoral neck are one of the most common fractures in the elderly. The incidence of these fractures will increase significantly in the next decades as a result of increasing life expectancy. ⋯ With correct decision-making, proper reduction, and proper consideration of the biomechanical principle of three-point fixation, minimally invasive screw fixation of femoral neck fractures is a safe and inexpensive procedure even in elderly patients. The purpose of the current review was to give an overview of the history, current techniques and developments, results, limitations, and complications of closed reduction and internal fixation of intracapsular femoral neck fractures.
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Clin. Orthop. Relat. Res. · Jun 2002
ReviewDisplaced intracapsular hip fractures: hemiarthroplasty or total arthroplasty?
The role of total hip arthroplasty for the treatment of displaced intracapsular fractures of the proximal femur in active patients is controversial. Some authors have shown that such patients, when treated with a bipolar or unipolar hemiarthroplasty, are at increased risk of having acetabular erosion develop that might require later revision to a total hip replacement. ⋯ Although the current belief is that there is a place for primary total hip arthroplasty after intracapsular hip fracture, and that this procedure should be reserved for patients with preexisting symptomatic acetabular disease, in a preliminary prospective comparative study of 46 active patients without preexisting acetabular disease, the current author found better results with cemented Charnley's total hip arthroplasty than with cemented Thompson's hemiarthroplasty. Long-term outcome and more detailed indications for total hip replacement as the primary treatment for intracapsular displaced fractures of the proximal femur are topics for additional study.
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Clin. Orthop. Relat. Res. · Jun 2002
Ipsilateral femoral neck and shaft fractures: complications and their treatment.
An ipsilateral femoral neck fracture occurs in approximately 6% to 9% of all femoral shaft fractures. Despite this relatively common presentation, decision-making often is difficult. Furthermore, the risk for complications is greater in the treatment of this combination injury pattern than for single-level fractures. ⋯ The femoral shaft nonunion proved more difficult than expected to treat with some patients with femoral shaft nonunions requiring more than one operative procedure to achieve union. Lag screw fixation of the femoral neck fracture and reamed intramedullary nailing for shaft fracture stabilization were associated with the fewest complications. Therefore, this approach is recommended as the treatment of choice.