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?

Ankle fractures are among the most common type of fractures of our musculoskeletal system, and their rate has been constantly increasing over the past decades, not only in the young active patients but also in the elderly ones.

The stability of the ankle joint is assured by the configuration of the fibula, tibia and talus, as well as by its complex ligamentous system.

The optimal treatment of these fractures follows the basic rules of all joint fractures: it is achieved by restoring the ankle mortise and its stability, in order to prevent pain and the development of secondary arthritis.

Stable ankle fractures (e.g., isolated fractures of lateral maleolus) can be satisfactorily treated by closed methods, whereas unstable fractures (e.g., bimaleolar, bilameolar equivalents, trimaleolar) must be treated by open reduction and internal fixation.

However, one of the aspects that influence the final outcome of these fractures is the coexistence of soft tissue injuries and osteochondral fractures (particularly of the talus), especially if not detected in the X-ray or intra-operative, which will inevitably degenerate in a posttraumatic arthritis.

The authors present in this paper a retrospective study of all patients with ankle fractures treated operatively in a period of ten years (January 1993 and December 2003). It where reviewed 376 clinical processes, with a male patient predominance (57%). The fractures where classified according to the Dannis-Weber Classification, and the following items where evaluated: epidemiology, co-morbidities, surgery timing, hospitalization time, surgical options, surgical follow-up and complications. The final evaluation of the patients included clinical, functional and radiological aspects.

The authors concluded that in spite of the surgical treatment being well established and indicated in the unstable fractures, its results are frequently influenced by the epidemiologic cofactors, co-morbidities, injury mechanism, coexistence of soft tissue injuries or osteochondral fractures that many times are not detected.