Reduction and Fixation of Subcapital Fractures of the Femur

Abstract

Impacted and undisplaced subcapital fractures of the femur quickly unite after low angle nail or screw fixation and immediate weight bearing. Apart from the onset of late superior segmental collapse in the small proportion of impacted fractures when the capital fragment lies in an extreme valgus position, these fractures present no surgical problems. On the other hand, displaced subcapital fractures are beset by a host of problems, many of which have been created by poor radiography or by mistaken interpretations of the radiographs themselves. In the treatment of displaced intracapsular fractures of the hip, cross screw fixation has proved to be a more effective way of maintaining good reduction than Smith-Petersen or Kiintscher low angle nailing. And despite its technical difficulties I still prefer to use this method of fixation with the proximal screw in its modified position of increased obliquity. Providing further proof that fully reduced subcapital fractures of the femur will unite as readily as other skeletal injuries if they can be held in full reduction until union is complete, cross screw fixation is regarded merely as an additional step in the ladder leading to the discoven' of a less complicated form of fixation. The problems of displaced subcapital fractures of the femur are unlikely to be clarified until a consistently successful method of realigning the fragments has been found and a simple and foolproof fixation procedure has been discovered. When these requirements have been met, and the treatment of these common and distressing fractures can be confidently delegated to the junior members of our staff in the knowledge that they will encounter none of the present embarrassments of treatment, the management of displaced subcapital fractures of the femur will cease to be the controversial subject that now clamors for so large a share of the surgical literature. Few contributions to the literature on any scientific subject can hope to convey more than a single message to the reader, and throughout the foregoing discussion an attempt has been made to emphasize — as many others have done in the past — that full and stable reduction is the first essential in the treatment of what must still be regarded as the “unsolved” though by no means the “unsolvable” fracture.