Abstract
Introduction: Primary fixation of displaced sub-capital fractures with low morbidity and low mortality offers an approach to a very common problem. The vast majority of patients receiving this form of treatment will not require further surgery. When confronting with the problem of primary arthroplasty which includes a higher morbidity and higher mortality, a higher infection rate and the possibility of prosthetic loosening especially in young patients, the choice seems clear.
Material and method: Between 1995 and 2000, a series of 21 patients (15f, 6m) were admitted for a displaced subcapital fracture (16 type Garden III, 5 type Garden IV) to our clinic. All the patients were operated 24 to 36 h after admission.
The mean age was 48y. The technique consists of:
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Anatomic reduction (with a C-arm), which was the most crucial point of the technique.
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Secure fixation with three cannulated screws (Asnis)
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A like tube graft from the iliac crest was placed on the neck of the femur, posteriori to increase the vascularity of the head. Weight bearing was permitted after 6 m and if the fracture was healed.
Results: The mean follow-up was 34 m. We did not have any osteonecrosis of the head. No complications. The mobility of the hip was normal in all patients. There were two cases with delayed union and one case with non-union due to a distention at the site of the fracture after the reduction_
Conclusion: We believe that this technique, especially the combination of an anatomic reduction of the fracture and the use of a cancelocortical graft is a very prospective alternative to a prosthetic replacement in relatively young patients.
The abstracts were prepared by Eleni Koutsoukou. Correspondence should be addressed to him at the Hellenic Association of Orthopaedic Surgery and Traumatology (HAOST), 20, A. Fleming str, 15123 Marousi, Athens, Greece.
