In this series, open repair with use of a locked plate resulted in better outcome scores than did hemiarthroplasty in similar patients, especially in those with a three-part fracture, despite a higher overall complication rate. Open reduction and internal fixation of fractures with an initial varus extension pattern should be approached with caution.

Neer 3- and 4-part proximal humeral fractures in older patients with initial varus angulation of the humeral head had a significantly worse clinical outcome and higher complication rate than similar fracture patterns with initial valgus angulation. Two factors had significant influence on final outcome in these fracture patterns: initial direction of the humeral head angulation and length of the intact metaphyseal segment attached to the articular fragment. The best clinical outcomes were obtained in valgus impacted fractures with a metaphyseal segment length of greater than 2 mm, and this was independent of Neer fracture type. Humeral head angulation had the greatest effect on final outcomes (P < 0.001), whereas metaphyseal segment length of less than 2 mm was predictive of developing avascular necrosis (P < 0.001).

We compared the results of the surgical treatment of trochanteric hip fractures before and after surgeons had been introduced to the tip-apex distance (TAD) as a method of evaluating screw position. There were 198 fractures evaluated retrospectively and 118 after instruction. The TAD is the sum of the distance from the tip of the screw to the apex of the femoral head on anteroposterior and lateral views. This decreased from a mean of 25 mm in the control group to 20 mm in the study group (p = 0.0001). The number of mechanical failures by cut-out of the screw from the head decreased from 16 (8%) in the control group at a mean of 13 months to none in the study group at a mean of eight months (p = 0.0015). There were significantly fewer poor reductions in the study group. Our study confirms the importance of good surgical technique in the treatment of trochanteric fractures and supports the concept of the TAD as a clinically useful way of describing the position of the screw.

We compared the results of the surgical treatment of trochanteric hip fractures before and after surgeons had been introduced to the tip-apex distance (TAD) as a method of evaluating screw position. There were 198 fractures evaluated retrospectively and 118 after instruction.The TAD is the sum of the distance from the tip of the screw to the apex of the femoral head on anteroposterior and lateral views. This decreased from a mean of 25 mm in the control group to 20 mm in the study group (p = 0.0001). The number of mechanical failures by cut-out of the screw from the head decreased from 16 (8%) in the control group at a mean of 13 months to none in the study group at a mean of eight months (p = 0.0015). There were significantly fewer poor reductions in the study group.Our study confirms the importance of good surgical technique in the treatment of trochanteric fractures and supports the concept of the TAD as a clinically useful way of describing the position of the screw.

HAC is an effective adjuvant in treating chronic osteomyelitis in a rat model when using a void-fill placement technique.