Introduction: We studied the possible causes of intraoperative metaphyseal fractures in elderly patients with displaced intracapsular fracture neck of femur treated with an HAC coated bipolar hemiarthroplasty and their effect on patient morbidity.

Methods: 326 patients with 337 displaced intracapsular fractures admitted from November, 2001, to November, 2005 were included. They underwent Furlong bipolar hemiarthroplasty marketed by Joint Replacement Instrumentation Ltd (JRI). The operations were performed by employing a similar technique and anterolateral approach. Postoperative management was same.

Results: Thirty five (10.25%) patients sustained an intraoperative metaphyseal fracture. We found a strong correlation between the incidences of metaphyseal fracture and stem size. Size 9 stem was used in 80 patients without any fracture. Stem size 10 was used in 159 patients and was associated with metaphyseal fractures in 14 patients (8.80%); size 12 stem was used in 98 patients with 21 metaphyseal fractures (21.42%). Vancouver type AL fractures were 26 and 9 type AG. The fracture was found to be unstable and fixation was undertaken in 7 patients. The mean hospital stay for the patients without metaphyseal fracture was 24 days (range 2–83) in comparison to 30 days (range 17–96) for patients with fractures.

Thirty one patients presented from 3–18 months after operation with hip related problems, 17 had thigh pain, 10 periprosthetic fractures but 8 of these 27 had history of intra-operative metaphyseal fractures. Four patients had revision surgery, one each for acetabular erosion and sinking of prosthesis due to old metaphyseal fracture, two had Girdlestone arthroplasty due to deep wound infection.

Conclusion: We conclude that a size 12 stem was associated with high complications rate because there is a big jump for the elderly patients from size 10 to 12 due to the non-availability of size 11 stem in this system. We observed the effect on patient morbidity due to metaphyseal fractures.

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.