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.

The use of hybrid þxation (cementless acetabular component and cemented femoral component) in primary total hip arthroplasty has been based on several observations: 1. The long-term problems associated with cemented acetabular þxation 2. The durable long-term results reported with cemented femoral þxation and 3. The encouraging reports of different centers on using the above technique. Methods: Between 1992 and 1997, 194 primary hybrid total hip arthroplasties were performed in our department in 171 patients. Follow up was performed at 5 to 10 years after the procedure. The average age at the time of the procedure was 69 years (range, 44 Ð 82 years). There were 102 women (123 hips) and 69 men (71 hips). 2 different groups of arthroplasties were used; one consisting of a microporous coated cup and one consisting of a hydroxyapatite-layered cup. The patients were prospectively observed clinically using the Harris Hip Score and radiographically. Results: The Harris Hip Score was preoperatively 43 in average (range, 15–55) and postoperatively increased to 88 points (range, 61–100). Five arthroplasties were revised; 1 due to acetabular loosening, 3 due to femoral loosening and 1 due to aseptic loosening. No cup migration of more than 1 mm could be observed. There were no radiolucencies around any of the screws used for the þxation of the cup. Conclusions: The clinical results of the hybrid total hip arthroplasties show excellent intermediate period results in respect of clinical performance and þxation durability.