Introduction: For the health-care system and for society in general, fractures of the femoral neck are epidemic among the elderly. With increased life expectancy, this type of pathology will continue increasing in the future. The study of possible biological causes of this phenomenon will provide better understanding of the pathology and help us prevent such fractures. Different genes involved in the synthesis of nitric oxide and interleukins are related to the occurrence of fractures of the femoral neck.

Materials and methods: We studied 111 patients with fractures of the femoral neck between 2002 and 2004 and a control group of 127 patients operated on for total hip or knee replacement in the same period. In both groups we looked at different genetic polymorphisms of IL-1 alpha, IL-1 beta, IL-1 RA, NOS2 and NOS3. We also measured the levels of IL-1 beta, IL-6 and TNF alpha in patient sera.

Results: We found a significant difference for certain genetic polymorphisms related to IL-1 beta and NOS3 and patients with fractures of the femoral neck.

Conclusions: There are different genes related to inflammatory reactants which are significantly related to the presence of fractures of the femoral neck.

Introduction and Objectives: Though not a common disease, proximal femoral epiphysiolysis (PFE) is one cause of premature degeneration of the joint. The aetio-pathogenesis is unknown. The challenge with this disorder is making an early diagnosis. This study presents the experience of our center in surgical treatment of this condition.

Materials and Methods: This is a retrospective study of 27 cases of PFE in 25 patients treated between 1990 and 1998, analyzing therapeutic management at the time of presentation and clinical, radiographic, and subjective findings in the short and medium terms. Based on duration of symptoms, the disorder is classified as acute, chronic, or subacute. Degree of displacement is classified as mild (less than 30%), moderate (30–60%), and severe (great than 60%). Dunn and Angel’s criteria were used for clinical evaluation, as modified for this study. Radiographic follow-up was based on the capitodiaphyseal Southwick angle, measuring the amount of correction postoperatively and in the medium-term examination.

Results: There were 17 males (63%) and 10 females (37%). Average age was 12.5 years. The right side was affected in 10 cases (40%), the left in 13 (52%), and both sides in 2 (8%). The majority of patients presented with chronic epiphysiolysis (44%) with mild displacement (74%). In most cases, surgical intervention consisted of in situ fixation with or without a previous attempt at reduction, based on the degree of displacement on an orthopaedic table with scope guidance. Fixations were performed primarily with Kirschner wire or cannulated screws. Preoperative complications included incomplete reduction of the fracture, breakage of the Kirschner wire, and superficial infection of the surgical wound.

Discussion and Conclusions: The worst results were seen in patients with epiphysiolysis with severe initial displacement and in patients who developed aseptic necrosis of the femoral head or chondrolysis. Intra-articular penetration with this material and valgus positioning should be avoided. At present, we are doing the fixation of the epiphysis using a single cannulated screw. We believe early detection of the process is very important in cases featuring gradual displacement.