Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Femoral neck fractures in young patients are a relatively rare event and are often the consequence of a high-energy injury. Concomitant injuries are present more than 50% of the time. Previous reports have found the rate of nonunion and avascular necrosis in this population to be as high as 35% and 45%, respectively. The salvage options, which tend to yield more acceptable results in elderly patients with femoral neck fractures, yield disproportionately poor results in young, active patients who are often productive members of the labor force. Many reports exist in the literature evaluating the various treatment options of these injuries. This review will address the epidemiology and diagnosis of the injury. In addition, the various treatment options in the acute presentation, as well as options available for treating the sequelae of femoral neck fractures in the young, will be discussed. Although longer life expectancy and the sustained activity level of many people previously considered elderly has blurred the definition of "young," this review will use the available literature dealing with skeletally mature patients up to the age of 60 years.

No abstract

We describe the clinical outcome of a technique of surgical augmentation of chronic massive tears of the rotator cuff using a polyester ligament (Dacron) in 21 symptomatic patients (14 men, seven women) with a mean age of 66.5 years (55.0 to 85.0). All patients had MRI and arthroscopic evidence of chronic massive tears. The clinical outcome was assessed using the Constant and Murley and patient satisfaction scores at a mean follow-up of 36 months (30 to 46). The polyester ligament (500 mm × 10 mm) was passed into the joint via the portal of Neviaser, medial to the tear through healthy cuff. The two ends of the ligament holding the cuff were passed through tunnels made in the proximal humerus at the footprint of the insertion of the cuff. The ligament was tied with a triple knot over the humeral cortex. All the patients remained free from pain (p < 0.001) with improvement in function (p < 0.001) and range of movement (p < 0.001). The mean pre-operative and post-operative Constant scores were 46.7 (39.0 to 61.0) and 85.4 (52.0 to 96.0), respectively (p < 0.001). The mean patient satisfaction score was 90%. There were two failures, one due to a ruptured ligament after one year and the other due to deep-seated infection. The MR scan at the final follow-up confirmed intact and thickened bands in 15 of 17 patients. This technique of augmentation gives consistent relief from pain with improved shoulder movement in patients with symptomatic massive tears of the rotator cuff.

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.