A CONTINUING END-RESULT STUDY OF INTRACAPSULAR FRACTURE OF THE NECK OF THE FEMUR

Abstract

We have presented a study of 100 additional intracapsular fractures of the neck of the femur with a 94 per cent. follow-up. However, only eighty-two of these patients could be fully studied because six were lost to follow-up and twelve died before the end results could be determined. We cannot consider these deaths as other than unfortunate results, but we cannot evaluate the fractures in these twelve cases. Eighty-three per cent. of these patients have been women, and the average age of the group was seventy-two years at the time of the fracture. The average age in this group is seven years greater than the average age for the three previously reported series of 235 patients. All but one of the nineteen fractures without displacement united without complication within four months of the operation. The incidence of union in the group of sixty-three patients with fractures with displacement is almost 78 per cent., which represents no essential change from the incidence in the preceding group of seventy-four patients with a similar type of fracture. Union of these fractures with displacement in this series occurred in an average of 7.5 months after reduction and fixation. Circulatory disturbance in the femoral head of united fractures with displacement has occurred in almost 25 per cent. of the current series, but only eight of the thirteen patients who have this complication have shown subjective or objective evidence of disability. Considering the entire group of eighty-two patients available for study, we have had completely satisfactory results,—that is, union of the fracture with no evidence of circulatory impairment of the femoral head in 67 per cent. If we consider the five patients with asymptomatic circulatory disturbance to have had satisfactory results, we might then claim entirely satisfactory results in 73.1 per cent. Considering the fractures with displacement alone, completely satisfactory results have occurred in slightly under 57.2 per cent. If the four patients in this group with asymptomatic circulatory disturbance of the femoral head are considered to have had satisfactory results, we might again claim satisfactory results in 65 per cent. of the fractures with displacement. In a previous report, we stated that a completely satisfactory end result in two of three of these fractures with displacement was the best that we could achieve. We have not improved on this, but perhaps this is understandable when it is considered that we are dealing with a group of patients seventy-two years old. We have learned how to salvage some of our unsatisfactory results by means of a prosthetic hip replacement when it has been properly indicated, with due regard to the limitation of such a replacement. We are not ready to render a final opinion on this matter at this time. We have, however, seen no prosthetic hip replacement which can compare favorably with a united fracture with a living femoral head.