Internal fixation of subcapsular fractures of the femoral neck

Abstract

Beside of modern surgical and implant techniques and basic pathophysiological knowledge, internal fixation of subcapsular fractures of the neck of the femur is still known to be connected with a high rate of complications. Implant failure, the typical early complication arising within the first 3 months, non-union, avascular necrosis of the femoral head and late segmental collapse are the typical complications. The type of fracture, timing of operation (emergency operation), quality of reduction and implant positioning have all been shown to predict outcome significantly. However, it is also suggested that further therapeutical interventions like intra-articular pressure decrease by evacuation of hematoma, the kind and technique of reduction, special surgical techniques and postoperative treatment can influence outcome, as well as patient-associated factors like age, degree of osteoporosis, neurological disease, and alcoholism. The superiority of one of the 100 different existing implants have not been proved either by clinical or by biomechanical trials. However, besides screw osteosynthesis, the sliding screw plate and less often sliding nail plate implants are commonly used. Because of the very different biomechanical principles it is of great importance to adhere to the special operative techniques to avoid intraoperative complications that might cause treatment failure. To reduce the frequency of these almost always fatal and in special circumstances lethal complications, we need some more detailed information from good clinical trials and sufficient external quality assurance.