Compression screw fixation for displaced subcapital fracture of the femur. Success or failure?

Abstract

We report a prospective study of 198 cases of subcapital fracture of the femur treated by closed reduction and fixation with a sliding compression screw-plate. This was done without regard to the patient's age or the Garden stage of the fracture. Early weight-bearing was encouraged. Of the displaced fractures 23% failed in the first year because of non-union or infection. Of the fractures which united 27% had developed avascular necrosis after three years. Despite this we believe that the sliding 78 THE JOURNAL OF BONE AND JOINT SURGERY

Internal fixation of femoral neck fracture: No difference between the Rydell four-flanged nail and Gouffon's pins

“…The type of follow-up will influence the results of the study (Skinner andPowles 1986, Frandsen 1986), and as shown here (Table 1). Therefore, we have also presented our results using an actuarial method, which takes in account patients with different periods of follow-up (Table 2).…”

“…Therefore, we have also presented our results using an actuarial method, which takes in account patients with different periods of follow-up (Table 2). This statistical method was well described by Dobbs (1980) when assessing total hip replacement and by Skinner and Powles (1986) when assessing femoral neck fracture. When comparing the results of treatment of fracture of the femoral neck, several problems arise.…”

Fixation of displaced femoral neck fractures: A comparison between sliding screw plate and four cancellous bone screws

“…This secures an optimum utilization of the observations and therefore the highest statistical precision. The actuarial method was well described by Dobbs (1980) when he assessed the survivorship of Stanmore hip replacements, and by Skinner & Powles (1986) when they assessed the failure rate after SSP fixation of femoral neck fractures. A direct comparison with the union rates from previous studies is not possible, but the "survivorship table" ( Table 3) shows all the relevant data concerning union and nonunion from our study.…”

“…The union rates after fixation with a SSP were in the beginning unsatisfactory (Charnley 1960, Hargadon et al 1963. The early results of the Richards@ lag-screw design were better (Clawson 1964, Rau et al 1982, and the latest published series have shown results among the best in the treatment of femoral neck fractures (Frandsen et al 1984, Norkild & Sonne Holm 1984, Skinner & Powles 1986. In the few existing comparative studies, SSP fixation was found to be superior both to McLaughlin nailplate fixation (Svenningsen et al 1984) and to sliding nail plate fixation (Nordkild et al 1985).…”

“…The stability of the weight-bearing unit is increased when compression is applied across the fracture line (Kaessman et al 1972). This can be obtained with the SSP fixation devices by means of a compressing screw (Charnley 1957, Hargadon & Pearson 1963, Svenningsen et al 1984, Ort & LaMont 1984, Skinner & Powles 1986). Because of the risk of breaking the trabecular bone thread by tightening the compressing screw, it was used with caution in our patients and was not applied if the bone structure was thought to be weak.…”