Surgical approaches and ancillary techniques for internal fixation of intracapsular proximal femoral fractures.

Abstract

In fixation of intracapsular hip fractures, different implants, surgical approaches and ancillary manoeuvres have been employed to improve the reduction, and the stability of the reconstruction, in an attempt to reduce the frequency of non-union and aseptic necrosis of the femoral head. To compare alternative surgical approaches and ancillary techniques in internal fixation of intracapsular hip fractures which have been subjected to randomised trials in elderly people. The Cochrane Musculoskeletal Injuries Group trials register, Medline, and reference lists of relevant articles were searched. Date of the most recent search: June 1998. All randomised and quasi-randomised trials investigating operative technique for the treatment of intracapsular hip fractures. Two reviewers independently assessed trial quality, by use of a ten-item checklist, and extracted data. One study of 94 patients studied the effect of impaction of the fracture at the time of surgery. The only outcome measure was bone scintimetry. There was no difference in scintimetry for the 29 undisplaced fractures but in displaced fractures treated with impaction the scintimetry appearances were significantly reduced implying a reduction of blood flow to the femoral head. One study of 220 patients compared the results of fractures treated with compression against those without compression. Results for 156 patients at one year showed a tendency to a lower incidence of non-union for those fractures treated without compression. One study of 49 patients noted a tendency to a reduced mortality for closed reduction of the fracture as opposed to open reduction. Non-union of the fracture was more common after closed reduction. Insufficient evidence exists from randomised trials to confirm the benefits of open or closed reduction or for intra-operative impaction or compression of an intracapsular fracture treated by internal fixation.