This study reviews Total Hip Arthroplasty (THA) in the subcapital femoral neck fracture population looking at early complications. Primary THA’s performed in our institution for femoral neck fractures between 1999 and 2001 were reviewed. The case records were obtained from the hospital patient information database. Medical charts, including operation and outpatient notes, were used to obtain information on the level of experience of the surgeon, supervision and complications. Sixty five THA’s were performed on 65 patients with the average age of 77. Trainee Registrars performed 62%, 15% with a consultant assistant and consultants performed 38%. There were 19 (30%) medical complications giving a total complication incidence of 38%. All of the procedures were performed via the Hardinge direct lateral approach. There were 6 (9%) surgical complications, including one deep infection requiring revision. There were no dislocations or peri-operative deaths. The one-year mortality was 9% (equal to expected mortality of age related population without fracture). Primary THA’s for displaced subcapital fracture in “community ambulators” is a safe and reliable procedure with an acceptable rate of surgical complications. Although there were a large number of minor medical complications documented, the 12-month mortality for this group remained the same as the population normal

Aims: The aim of the study is to present early results in the treatment of hallux valgus with a new 3D subcapital metatarsal osteotomy, based on a original Wilson osteotomy. 3D subcapital metatarsal osteotomy is a simple and fast procedure where we shift capitis of metatarsal bone to lateral and plantar, and fix with K-wire. Materials and methods: In the period from 1997 to 2003, 25 patients (all females) and 34 feet were operated. The patients were followed up from 1 to 7 years. The age of the patients varied from 33 up to 60 years (median value – 45 years of age). Indications for the corrective metatarsal osteotomy were the angle of hallux valgus more than 20 degrees, intermetatarsal angle more than 20 degrees as well as pain due to shoe pressure over the medial side of metatarsophalangeal joint, and aesthetic reasons. In this study all feet were evaluated (radiological, clinical and subjective evaluation). Results: The angle of hallux valgus was 20 to 50 degrees (mean value – 32.3 degrees) preoperatively, and dropped to 2 to 35 (mean value – 12.47 degrees) postoperatively. Intermetatarsal angle was 10 to 22 (mean value – 15 degrees) before operation, and 3 to 15 degrees (mean value 5 degrees) after operation. The DMA angle was 0 to 30 (mean value – 15 degrees) before operation, and 0 to 20 degrees (mean value – 20 degrees) afterwards. Shortening of first metatarsal bone was 1 to 8 mm (mean – 3 mm). We did not have any complications. Conclusion: Early results of this study show that new 3D subcapital metatarsal osteotomy in treatment of hallux valgus is a good method. It is necessary to follow strict and precise criteria in the indication of operative procedure in treating hallux valgus. The procedure itself is simple and fast

Subcapital fractures about the hip continue to be a common clinical scenario with which we all face. There are estimated to be over 350,000 hip fractures annually in the U.S. with 40% being displaced femoral neck fractures. The mean cost is over $30,000. Optimizing surgical care is essential with the overall goal being to perform the most effective treatment with the lowest risk of reoperation that provides the best postoperative function and pain relief. In the “young” (which is often defined as whatever age is younger than you!) reduction and internal fixation is often the most effective retaining the native femoral head. The risk of non-union and AVN is often less than potential complications that can follow an arthroplasty with 40% of displaced fractures treated with ORIF eventually requiring reoperation. Essentially for every 100 patients that undergo ORIF for displaced femoral neck fracture, choosing arthroplasty instead results in 17 conversions avoided. In the “elderly” in general we treat all displaced fractures with a total hip replacement which reduced re-admissions and is more cost effective for displaced femoral neck fractures. Aside from the medical morbidity following an arthroplasty dislocation is the primary concern. We have found the anterolateral approach reduces this significantly. Non-displaced fractures that are valgus impacted and biomechanically stable are treated with cannulated screws. Perhaps it can be argued that a hemiarthroplasty (bipolar or monopolar) has a lower risk of dislocation compared to a total hip replacement if performed by a surgical team with less frequent total hip replacement experience. However, total hip replacement results in less pain and better function when the patients are independent with intact mental status (patient not the surgeon…!). My algorithm is non-displaced valgus impacted or “stable” fractures undergo cannulated screws and the displaced fractures receive a total hip arthroplasty via an anterolateral approach

Aims: This is a retrospective study, comparing prosthesis survivorship, complications and functional results in geriatric patients treated with different types of prosthetic replacement for subcapital fractures of the hip. Methods: In the years 1985–1999, 292 elderly (aged 65–80 years) patients with displaced, nonpathologic sub-capital hip fractures were operated on. Of those, 143 were lost to follow-up; therefore, prospectively collected data of 149 patients were retrospectively reviewed. 54 patients received a unipolar, 48 a bipolar prosthesis and 47 underwent a primary total hip arthroplasty (THA). Mean follow-up was 5.3 years. The patients did not differ in pre-injury characteristics. Analysis of variance was used to compare the three patient groups in terms of early and late complications, need for revision surgery, and functional outcome. Results: A statistically signiþ-cant difference was noted, regarding need for revision surgery, since 5 (9.25%) of the unipolar and 5 (10.4%) of the bipolar prostheses had to be re-operated, compared to 2 (4.25%) from the THA group. Of note, 4 of the revised bipolar prostheses had loose stems. The THA group also proved superior, when recovery of instrumental activities was investigated. Conclusions: Elderly patients, whose biologic age poses high functional demands on them, with a displaced subcapital hip fracture, should receive a total hip arthroplasty. Stem loosening seems more likely, as a mode of failure, in bipolar prostheses, than acetabular erosion

Purpose: We will present our experience regarding sub-capital femoral fractures that were treated by cemented bipolar hemiarthroplasty with Chanley stem during the years 1987 to 2002. Method: We treated 159 patients with subcapital femoral fractures, type Garden stage 3 and 4. Of those 57 were men and 102 women aged between 65 and 85 years old. All the patients underwent surgical treatment by the same surgeon team, using cemented bipolar hemi-arthroplasty Hastings types, with Chanley stem. The preferred surgical approach was the anterolateral with partial incision of the gluteus medius muscle and preservation of the posterior capsule of the hip joint, so that the prosthesis would be stable and the abductor muscles retained their strength. Results: The observation time ranged from 6 months to 15 years. During this period 38 patients passed away and 24 never returned for follow up. The observed complications were: 1 aseptic loosening of the femoral stem that was dealt with THA, 1 superficial inflammation that was taken care of with surgical cleaning and antibiotic administration and 1 dislocation of the metal cup (with the internal polyethylene bearing) from the femoral stem that was corrected by OR. Postoperative hip mobility was found to be excellent (62%), fair (32%), poor (6%). 6 patients reported light to moderate pain during walking. We observed that the dual motion of the bipolar prosthesis is considerably reduced and eventually disappears over time. Conclusions: From our long time experience regarding subcapital femoral fractures types Garden 3 and 4 in patients aged between 65 and 80 years old, we believe that the cemented bipolar hemiarthroplasty is a very good method of choice

Introduction:- We reviewed 69 patients with subcapital fracture neck of femur treated with two hole plate DHS and parallel de-rotation screw into the cranial part of the femoral head between January 2000 to January 2005. Methods:- Patients were selected for fixation by having Garden 1 to 4 fractures, being younger, more active and mobile. Reduction was classified as “good” when residual angulation in the lateral projection was less than 15 degrees, no varus angulation and good alignment in the calcar area. Screw position was considered “good” when there was less than 10 degrees deviation in the direction of screws, screw threads not bridging the fracture site, screw tips less than 5mm from subchondral bone and no signs of intra-articular penetration. The fracture was considered healed when bridging of trabecular bone was present. Patients were reviewed until they were pain free at rest or on walking and had radiological healing of fracture. Results:- 13 had Garden 3 & 4, 46 had Garden 1 & 2 and 10 had impacted fractures. Sixty eight patients had operation within 24 hours in the next available trauma list. Average age at operation was 70 years (range 21– 89) and hospitals stay 13 days (range 2–52). Good reduction was achieved in 61 patients, 54 of these had good screw position, 8 patients (11%) had combination of poor reduction and poor screw position; five of them had loss of fixation within 6 to 12 weeks postoperatively, one each had segmental collapse and avascular necrosis between 12 to 24 months of operation. Conclusion:- Their was no re-displacement, non-union, avascular necrosis or segmental collapse when fractures were well reduced and had good screw position. Two hole plate DHS and a parallel de-rotation screw has high rate of fracture union. We recommend its use for treatment of subcapital femoral neck fractures

Aims: Demonstration of our results from treating displaced femoral neck fractures with a new method of closed reduction and internal þxation. Methods: Between 1995 and 1999 we treated 37 patients (21 female and 16 male) with displaced subcapital femoral fractures in the age group between 65 and 70 years. The selection of the appropriate treatment was according to our treatment algorithm based on the age, the displacement of the fracture, the general physical condition, the bone density and the functional demands of the patient. We performed closed reduction using an alternative method. The patient is placed on the traction table without traction of the injured limb. We apply traction on the abducted (> 45¡) healthy limb until the pelvis is mobilized. Finally, a radiological check is performed to decide whether we should modify the traction. This method is also used in other age groups. In 1 case closed reduction was not successful and an open reduction was performed. As a method of internal þxation we used 3 cannulated hip screws. Follow-up of the patients exceeded the period of 2 years. Results: The average Harris Hip Score at 2 years was 76. There were 3 cases of avascular necrosis and 2 cases of non-union of the fracture. In all these 5 patients we performed a conversion to total hip arthroplasty. Conclusions: Although displaced subcapital femoral fractures still remain the unsolved fractures, especially in ages between 65 and 70 years, proper selection of patients and satisfactory reduction of the fracture are the most important factors for a successful internal þxation of the fracture. The proposed alternative method of closed reduction leads to favorable results, comparable to the classical methods of closed reduction

It remains a matter of debate whether to fix or to replace subcapital fractures of femur, particularly the displaced one’s. Orthopaedic surgeons face the challenge of providing the best treatment for intracapsular fracture of the femur. Most authors agree that in young demanding patients with no displacement fracture, the internal fixation techniques should be used with the proper anatomical reduction and without delay. However the risk of reoperation is somehow near 30%. On the other hand patients with a displaced fracture will need to consider a few more options like the arthroplasty. In this 5 year retrospective study we compare the mortality, morbidity, functional status of patients following each of the principal methods of treatment for subcapital fractures of the femur. We could in this way observe a group of 48 patients operated between 1998 and 2002 and wich we divided in two sub-groups according to the AO classification of their fractures. The first group had 20 patients all classified as B1 fractures with no displacement, they were treated mainly by internal fixation. The second group had 28 patients with B3 fractures with displacement, they were treated mainly by replacement of the femoral head. All of these patients were followed in an average of 20 and 24 months respectively. We found no significant difference in the mortality rate, average age, sex, ethiology in the two sub-groups, but the reoperation rate of the internal fixation, mainly the first sub-group was four times the arthroplasty. The internal fixation did have fewer immediate postoperative complications and shorter hospital stay. We also did find that in the first group we had 6 revisions because implant failure and non-union, in the second group we had 2 revisions because of implant failure. Patients submitted to internal fixation had, in long term, more severe pain and impaired walking than those with arthroplasty. The average Harris Hip Score was 79 for the first group and 82 for the second group. We can conclude, although this is a very small sample, as in other series that the displaced fractures have a more consensual treatment specially the older patients in which the treatment of choice is arthroplasty. In the non displaced fractures the first choice is internal fixation, but because of the high rate of the non union the doubt is always present whether to fix or replace. Is our patient willing to stand for that?

Objective: To evaluate the results of cannulated screw fixation for subcapital neck of femur fractures in our unit. Materials and Methods: 104 patients underwent the above procedure in our unit over a two year period (Jan 2006 – Dec 2007). The case notes and xrays of these patients were reviewed retrospectively. The age group varied between 31 and 100 years. Results: There was 20% incidence of complications. There were 9 cases of AVN and 10 cases of screws backing out and I case of subtrochanteric fracture. Of the 9 cases of AVN 3 were below 73 years of age and the rest had a mean age of 90.3 years. Conclusion: There is a high incidence of AVN in geriatric group requiring further surgery and cannulated screws fixation is not the optimal choice in geriatric group for varied reasons. Further review is to be carried out looking for the specific reasons of failure

Introduction and Objectives: This study examines the need for transfusion in trauma surgery for subcapital fractures of the femur (SFF) in a tertiary hospital and analyzes possible predictive factors. Materials and Methods: A prospective study was done using patients requiring surgical treatment for SFF in the year 1998. Patients younger than 65 years, those with hemopathies, and patients undergoing anticoagulant therapy were excluded from the study. The following variables were analysed: age, sex, haemogram at time of admission (haemoglobin [Hb], haematocrit [Hct], mean corpuscular volume [MCV], mean corpuscular haemoglobin [MCH], anisocytosis [area under the curve or AUC]; preoperative and postoperative Hb and Hct (preoperative values only if surgery did not take place within 48 hours of admission); time to surgical intervention, transfusions, and use of blood derivatives. Results: The study included 75 patients operated on for SFF. These included 18 with B1 fractures, 8 with B2, and 49 with B3 based on AO classification. There were 12 males and 63 females, and average age was 81 years (standard deviation [SD]=8). Average values upon admission were as follows: Hb 128 (SD=23) g/l, Hct 39% (SD=6%), MCH 30.3 pg, MCV 91.4 fL, and AUC 14.3%. Average time to surgical intervention was 5 days (SD=2.8). Types of surgical intervention included 23 screws (31%) and 52 partial hip prostheses (69%). Preoperative average haemogram values were Hb 119 (SD=12) g/l and Hct 36% (SD=4%). Forty-one patients (55%) received transfusions of concentrated red cells. Of these, 8 (11%) were preoperative, 8 (11%) were perioperative, and 31 (41%) were in the immediate postoperative period. Gender, age, MCV, MCH, and time to surgery were not found to be related to the need for transfusion. On the other hand, correlations were found between Hb at time of admission, postoperative Hb, anisocytosis, type of fracture, and type of surgical intervention. The only variable independently-related to the need for transfusion was Hb at time of admission. Discussion and Conclusions: In spite of the urgent nature of these cases, the results of this study suggest a need for further studies designed to improve the haematologic parameters for these elderly patients upon admission, such as the adoption of less aggressive measures and the establishment of a blood storage system for high-risk patients, with the aim of reducing the need for transfusions and the inherent risks of allogeneic blood transfusions

Aim:. Audit of the outcome of subcapital osteotomy for a series of cases of severe unstable slipped capital femoral epiphysis. Method:. 57 cases of unstable severe slipped capital femoral epiphysis were operated on by a single surgeon between 2000 and 2011. The procedure was performed through the anterior abductor sparing approach. Patients have been followed up prospectively and the results are presented at average follow up is 6.4 years with a minimum of 18 month follow to include all risks of avn. Results:. There were 35 males (average age 13.85 years) and 22 females (average age 12.4 years). Three syndromic cases, 2 Trisomy 21 (with no avn) and one pituitary/corpus callosum agenesis (developed avn) were included. 5 patients (8.7%) developed avn, one syndromic, another with noted avn on pre-operative MRI and the third with partially healed growth plate. Excluding these patients the avn rate was 2/54 (3.7%). Re-operations were performed on the avn group including two head neck debridements and valgus osteotomy, one head neck debridement alone and one arthrodesis. One patient is awaiting debridement and valgus osteotomy. One patient developed chondrolysis and has had no intervention 6 years. 2 patients developed asymptomatic heterotopic bone ossification and the incidence of lateral cutaneous nerve symptoms was 35% none requiring intervention. Leg length difference was less than 1 cm in those patients who did not develop avn. Conclusion:. This single surgeon audit shows lower risk of avn than and strengthens the argument for referral to specific centres for such conditions. Level of evidence: IV

Purpose: Describe our experience with our new approach for treating displaced subcapital femoral fractures in our active patients. Materials and Methods: From August 2005 till January 2008, 79 active patients were treated for displaced Sub-capital Femoral fracture by close reduction and internal fixation with Short Trochanteric Antegrade Nail (T.A.N.) (Smith& Nephew). Mean age 74.5 (range 38–93),. Partial weight bearing began 0–4 weeks post operation and Full Weight Bearing 4–8 weeks post operation. Patients were evaluated at 1,2,6,12& 24 months after the operation. Results: All patients returned to walk on their feet. The patients were scored by modified lower extremity questionnaire with mean results 4.1 (scale of 1–5, 1-poor, 5-excellent). There were no cases of implant failure. No cases of infections. Two patients had a cut-out of the implant and two other patients had a nonunion of the fracture. Those 4 patients (5.06%) were converted to a THR. There were no cases of avascular necrosis. Conclusions: Our complications rate for displaced sub-capital fractures treated by C.R.I.F. were lower than that reported for the alternative treatment modality. Our findings show that these fractures can be treated with a high rate of success by closed reduction and internal fixation with an intramedullary biaxial fixation in all age groups. With this simple and minimally invasive operation and the nail’s biaxial angular stability, we can achieve stable fixation. This procedure offers several advantages over hemiarthroplasty, by lowering the risk of immediate complications such as prolonged anesthesia, bleeding, infection, periprosthetic fractures and dislocations. Furthermore, the use of the short TAN preserves the femoral head and the normal anatomy in active patients in order to avoid the late complications of hemiarthroplasty

There is continuing debate among orthopedists regarding the appropriate treatment of femoral neck fractures, open reduction internal fixation (ORIF), Total hip arthroplasty (THA) or hemiarthroplasty. In 2003 310,000 patients were hospitalized for hip fracture in the United States and about one-third were treated with total hip arthroplasty. Worldwide, the total number of hip fractures is expected to surpass 6 million by the year 2050. In a survey distributed by the American Association of Hip and Knee Surgeons, and of the 381 members who responded, 85% preferred hemiarthroplasty, 2% preferred ORIF and 13% preferred THA. The decision to perform internal fixation, hemiarthroplasty, or THA is based on comminution of the fracture activity level and independence, bone quality, presence of rheumatoid or degenerative arthritis, and mental status. Evidence based practice indicates that in a young patient with good bone stock and a fracture with relatively low comminution an ORIF is the treatment of choice. If the patient has a comminuted fracture with poor bone quality, minimal DJD, no RA, and low activity demand a hemiarthroplasty is a reasonable choice. If the patient has a comminuted fracture with poor bone quality, DJD and high activity demand a total hip replacement is a reasonable choice.

Over the past decade there has been a shift in the approach to management of many femoral neck fractures. As noted by Miller et al. those trends are reflected in the practice patterns of surgeons applying for board certification through the American Board of Orthopaedic Surgeons. From 1999 to 2011 there was a trend toward total hip arthroplasty and corresponding small decreases in the use of hemi-arthroplasty and internal fixation for treatment of femoral neck fractures. For many years the treatment approach has been a simple diagnosis-related algorithm predicated upon classification of the fracture as displaced (historically treated with hemi-arthroplasty) or non-displaced (historically treated with internal fixation). More recently, however, the focus has shifted to a patient-centered approach. In the patient-centered approach factors such as age, functional demands, pre-existent hip disease and bone quality should all be considered. In the contemporary setting it is still important to distinguish between displaced and non-displaced fracture patterns. Non-displaced femoral neck fractures, regardless of patient age or activity, are well-suited to closed reduction and internal fixation, most commonly with three cannulated screws. The union rate is high in non-displaced fractures treated with internal fixation and the benefits of preserving the native hip joint are substantial. Displaced femoral neck fractures in younger active patients, particularly those without pre-existent hip arthritis, are best treated with early anatomic reduction and internal fixation. While a subgroup of young, active patients who undergo ORIF may fail, the benefits of native hip preservation in that group are again substantial. Displaced femoral neck fractures in older patients or those with substantial pre-existing hip arthritis are best treated with arthroplasty. The biggest practice change has been the trend to total hip arthroplasty as opposed to hemi-arthroplasty for a subgroup of patients. Total hip arthroplasty is now favored in almost all active, cognitively well-functioning patients as the degree of pain relief is better and the risk of reoperation is lower in the current era (32mm and 36mm femoral heads). Hemi-arthroplasty, either uni-polar or bi-polar, remains an appropriate treatment for cognitively impaired patients who also have limited functional demands in whom the risk of dislocation is particularly high.

To properly care for femoral neck fractures, the surgeon must decide which fractures are to be fixed and which fractures will require a prosthesis. In addition, the type of prosthesis, hemiarthroplasty versus total hip arthroplasty must be selected. Total hip arthroplasty is an option in the active elderly.

The literature supports internal fixation in non-displaced fractures. Current literature supports the fact that ORIF of displaced femoral neck fractures results in failure and re-operation of 20% to 30%. By considering arthroplasty when the patient has multiple co-morbidities including renal disease, diabetes, rheumatoid arthritis and severe osteoporosis the re-operation rate can be reduced significantly. The single most important factor in preventing failure with fixation is an anatomic reduction. A femoral neck fracture left in varus is doomed to failure and re-operation.

A prosthesis should be used in most displaced femoral neck fractures in patients physiologically older than 65. In active elderly patients total hip replacement should be considered. In elderly patients with multiple co-morbidities who are relatively inactive in a nursing home or lower level community ambulators, a hemi-prosthesis should be considered. The decision-making process is always shared with the patient.

When a prosthetic replacement is performed, the low level nursing home or community ambulator who is not expected to live longer than six to seven years is a candidate for a cemented hemi-arthroplasty. Studies report a 25% – 30% re-operation rate in hemi-arthroplasty if the patient survives greater than six to seven years. In the active elderly with little co-morbidity, a total hip replacement should be used. This is not only cost effective but provides the best pain relief of any of the options for treatment of displaced femoral neck fractures. Treatment of femoral neck fractures remains a challenge but the surgeon must select the proper treatment based on fracture displacement, physiologic age of the patient as well as co-morbidities of the patient.

Introduction The aim of the study was to review the results of total hip arthroplasty (THA) in relatively fit and mobile patients with Garden 3 and 4 fractures of the neck of femur.

Materials and methods 37 patients who underwent THA for displaced fractures of neck of femur between 1995 to 2001 were reviewed. Only those patients with 3 years or more follow-up were reviewed.

Results Average age was 67.7 years (37–80 years) with Male:Female ratio 5:32. Fracture involved left hip in 12 and right hip in 15 patients. Average Modified Barthel index before the fracture was 18.5 (13–20) and average Waterlow score was 12 (5–19). Majority were ASA grade II (22 patients). All patients were operated by the senior author. 31 hips were cemented, 1 uncemented and 5 hybrids. Canulated CF-30 (Sulzer, Switzerland) femoral stem was most commonly used (32 patients) and the acetabular component was Weber Metasul cup in most cases (33 patients).33 hips had metal-on-metal bearing surface and the rest had metal-on-polyethylene. Average hospital stay was 12.6 days; majority (33) of the patients were discharged home and the rest needed additional rehabilitation. Average post-operative drop in Hb was 2.63 and14 patients needed blood transfusion. Average transfusion was 0.86 units per patient. Average follow-up was 5.8 years (3–9.5 years). Complications included: wound leakage (5), minor wound dehiscence (1), DVT (3), pulmonary embolism (1), dislocation (1), per-operative femur fracture (1), peri-prosthetic fracture (2), stem loosening (1). 3 hips (8%) were revised (loosening 1, peri-prosthetic fractures 2). Average harris hip score at follow-up was 92 (66–100).

Conclusion In relatively fit, young and mobile patients, we recommend total hip replacement as the primary treatment since it promises better function and pain relief and avoids the drawbacks of internal fixation and hemiarthroplasty.

Introduction The aim of the study was to review the results of total hip arthroplasty (THA) in relatively fit and mobile patients with Garden 3 and 4 fractures of the neck of femur.

Materials and methods 42 patients with displaced hip fractures who underwent THA ≥ 3years ago were reviewed. One was lost to follow-up.

Results Average age was 67.17 years (SD-9.4, range 37–80 years) with Male:Female ratio 6:35. Average follow-up was 5.8 years (3–9.6 years). Average Modified Barthel index before the fracture was 18.63 (SD-2.08, range 13–20). Majority were ASA grade II (22 patients). 33 hips were cemented, 1 uncemented and 7 hybrids. Canulated CF-30 femoral stem was most commonly used (33 patients) and acetabular component was Weber cup in most cases (34 patients). 35 hips had metal-on-metal bearing surface and the rest had metal-on-polyethylene. Average hospital stay was 12.5 days (SD-7.84, range 6–43); majority (36) of the patients were discharged home and the rest needed additional rehabilitation. Average post-operative drop in Hb was 2.78 (SD-1.34) and 15 (36.5%) patients needed blood transfusion. Average transfusion was 0.85 units per patient. Complications included: minor wound dehiscence (1), DVT (3), pulmonary embolism (1), dislocation (1), per-operative femur fracture (1), peri-prosthetic fracture (2) and stem loosening (1). 3 hips (7.3%) were revised (loosening 1, peri-prosthetic fractures 2). Average harris hip score at follow-up was 91 (66–100). At final follow-up 24 patients were independently mobile without support, 12 used 1 stick, one used 2 sticks, 3 used a frame and 1 patient was wheelchair bound due to stroke.

Conclusion In relatively fit and mobile patients, we recommend total hip replacement as the primary treatment since it promises better function and pain relief and avoid the drawbacks of internal fixation and hemiarthroplasty.

Aim:Evaluate the results of primary cemented/cementless THA for the treatment of displaced femoral neck fractures.

Material-Method:121 pts with femoral neck fractures underwent THA 2.1 days on average after their admission.The mean follow up period 4.1 y.112 pts had Garden III-IV fractures,9 pts had Garden II fractures.A cementless THA was applied in 75 pts (Group A,average age 61.4 y),46 pts were treated with cemented THA (Group B,72.4 y).Last follow up evaluation with Harris Hip Score (HHS) and radiological assessment with the Engh/Wixon scores was available in 92 pts.In 25 elderly pts a cementless THA was applied due to established impairment of their cardiopulmonary status.

Results:The mean HHS was 82,3.Radiological score for the cementless THA:+5,8 for the cup and +6,4 for the stem according to Engh scale (satisfactory integration for the prosthesis Perfecta,Synergy) and a 74,8% liability of integration according to Wixon scale (Spotorno).Complications:Early dislocation 3,loosening 5,heterotopic ossification 8,periprosthetic fracture 1,femoral nerve paresis 1,wound infection 1.No systematic complications were noted in the elderly patients with cardiopulmonary disorders,possible due to selection of a cementless THA.

Conclusions:THA (cemented/cementless) for the treatment of displaced femoral neck fractures give very good midterm results.Cementless THA is probably the choice of treatment in elderly pts with cardiopulmonary disorders.

In 2000, Reinhold Ganz developed a surgical technique for treating slipped capital femoral epiphysis using his surgical hip dislocation approach to facilitate anatomical reconstruction of the slipped epiphysis—reportedly, without risk of avascular necrosis. This technique is now being adopted cautiously in paediatric orthopaedic centres internationally.

The technique will be described and early results presented. Complications and their treatments will also be discussed.

Early experience suggests morbidity following the procedure is not insignificant and until more corroborating safety data is available, the author suggests this technically demanding surgery should only be offered to children whose significant deformity would otherwise result in childhood disability.

Anatomic reduction (subcapital re-alignment osteotomy) via surgical hip dislocation – increasingly popular. While the reported AVN rates are very low, experiences seem to differ greatly between centres. We present our early experience with the first 29 primary cases and a modified fixation technique.

We modified the fixation from threaded Steinman pins to cannulated 6.5mm fully-threaded screws: retrograde guidewire placement before reduction of the head ensured an even spread in the femoral neck and head. The mean PSA (posterior slip angle) at presentation (between 12/2008 and 01/2011) was overall 68° (45–90°). 59% (17/29) were stable slips (mean PSA 68°), and 41% (12/29) were unstable slips unable to mobilise (mean PSA 67°). The vascularity of the femoral head was assessed postoperatively with a bone scan including tomography.

The slip angle was corrected to a mean PSA of 5.8° (7° anteversion to 25° PSA). We encountered no complications related to our modified fixation technique.

All cases with a well vascularised femoral head on the post-operative bone scan (15/17 stable slips and 8/12 unstable slips) healed with excellent short term results.

Both stable slips with decreased vascularity on bone scan (2/17, 12%) had been longstanding severe slips with retrospectively suspected partial closure of the physis, which has been described as a factor for increased risk of avascular necrosis (AVN). One of these cases was complicated by a posterior redislocation due to acetabular deficiency. In the unstable group, 4/12 cases (33%) had avascular heads intra-operatively and cold postoperative bone scans, 3 have progressed to AVN and collapse.

Anatomic reduction while sparing the blood supply of the femoral head is a promising concept with excellent short term results in most stable and many unstable SCFE cases. Extra vigilance for closed/closing physes in longstanding severe cases seems advisable. Regardless of treatment, some unstable cases inevitably go on to AVN.