Hook-pin fixation of subcapital fractures of the femur: an atraumatic procedure?

Abstract

Eighty-seven patients with subcapital fractures of the femur treated by hook-pin fixation were reviewed clinically and radiologically with an average follow-up time of 29 months. There were 58 undisplaced and 29 displaced fractures. Seven per cent of the undisplaced and 31 per cent of the displaced fractures developed avascular necrosis (AVN) and failure of fixation was seen in 3.5 per cent and 10 per cent respectively. Overall, 23 per cent of patients developed healing complications of which just over one-half had revision arthroplasty. The AVN rate in the undisplaced group was relatively low, though there was no clear advantage over simple screw fixation. In contrast, the incidence of AVN in displaced fractures was higher than with other methods. Fixation failure was related to surgical error in most instances.