It has been shown that raised intracapsular pressure causes avascular necrosis of the femoral head in experimental animals, but the relevance of this to clinical fractures of the femoral neck is controversial. We have studied 19 patients with intracapsular fractures of the femoral neck by pressure measurement and by ultrasonography to demonstrate capsular distension. The intra-articular pressure in Garden Grade I and II fractures averaged 66.4 mmHg with a maximum of 145 mmHg. In 10 Garden Grade III and IV fractures the average pressure was 28 mmHg with a maximum of 65 mmHg. Most of the recorded intracapsular pressures were high enough to have caused possible vascular embarrassment, and it is suggested that early decompression of the haemarthrosis should be considered

1. A series of 100 intracapsular fractures of the femoral neck treated with the Charnley compression screw is reported. 2. There were six deaths, and in patients reviewed long enough (seventy-five) there were eleven undisplaced fractures, with successful union in 8l·8 per cent, and sixty-four displaced fractures, with a union rate of 59·6 per cent. 3. If we exclude six failures of operative technique, there remain fifty-eight patients in whom the fracture was judged radiologically to have united in 65·5 per cent. 4. The Charnley compression screw is an effective method of internal fixation in such fractures, and non-union with this method is usually due to causes other than mechanical failure

Computed tomography was performed on 40 patients with recent hip trauma. Radiographs of 25 showed a fracture of the femoral neck with slight displacement; 24 of these had intra-articular fluid and 20 had a lipohaemarthrosis on the CT scan. In 15 patients, radiographs at the time of admission were normal but suspicion of fracture remained. A fracture was later verified in five patients, four of whom had lipohaemarthrosis on admission. In the remaining 10 patients no fracture could be detected; only one patient had a hip joint effusion but no free fat. Thus all 24 patients with lipohaemarthrosis had an intracapsular fracture of the hip. We suggest CT for patients with hip trauma and negative radiographs. The presence of a lipohaemarthrosis of the hip strongly suggests an intra-articular fracture of either the femoral neck or the acetabulum

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Despite multiple trials and case series on hip hemiarthroplasty designs, guidance is still lacking on which implant to use. One particularly deficient area is long-term outcomes. We present over 1,000 consecutive cemented Thompson’s hemiarthroplasties over a ten-year period, recording all accessible patient and implant outcomes.

We have compared the results and complications after closed and open reduction with internal fixation in young adults with displaced intracapsular fractures (Garden grades III and IV) of the neck of the femur. We also studied the risk factors which influenced nonunion and the development of avascular necrosis (AVN). A total of 102 patients aged between 15 and 50 years was randomised to receive either closed or open reduction. Both groups were compared for age, gender, time to surgery and posterior comminution as well as for union and complications. Using univariate and multivariate analysis the factors influencing nonunion and AVN were assessed. Of the 102 patients, 92 were available for review. There was no significant difference between the groups in terms of union (p = 0.93) and AVN at two years (p = 0.85). Posterior comminution, poor reduction and improper placement of the screws were the major factors contributing to nonunion. The overall incidence of AVN was 16.3% (15 of 92 patients) and it was not influenced by these factors. A delay of more than 48 hours before surgery did not influence the rate of union or the development of AVN when compared with operation within 48 hours of injury

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Few studies have investigated potential consequences of strained surgical resources. The aim of this cohort study was to assess whether a high proportion of concurrent acute surgical admissions, tying up hospital surgical capacity, may lead to delayed surgery and affect mortality for hip fracture patients.

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The aim of the HIPGEN consortium is to develop the first cell therapy product for hip fracture patients using PLacental-eXpanded (PLX-PAD) stromal cells.

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This study assessed the impact of COVID-19 on hip and distal femur fracture patient outcomes across three successive UK lockdown periods over one year.

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Hip fractures in patients < 60 years old currently account for only 3% to 4% of all hip fractures in England, but this proportion is increasing. Little is known about the longer-term patient-reported outcomes in this potentially more active population. The primary aim is to examine patient-reported outcomes following isolated hip fracture in patients aged < 60 years. The secondary aim is to determine an association between outcomes and different types of fracture pattern and/or treatment implants.

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Our rural orthopaedic service has undergone service restructure during the COVID-19 pandemic in order to sustain hip fracture care. All adult trauma care has been centralised to the Royal Shrewsbury Hospital for assessment and medical input, before transferring those requiring operative intervention to the Robert Jones and Agnes Hunt Orthopaedic Hospital. We aim to review the impact of COVID-19 on hip fracture workload and service changes upon management of hip fractures.

1 . The arterial pattern and the histological features in the femoral head and neck were studied at necropsy in twenty-five specimens with intracapsular fractures. An improved visual-arteriographic method employing barium sulphate dyed with Prussian blue was used. Twenty-three of the fractures were from a few days to twenty-four weeks old and two were seven and ten years old. Nineteen had been nailed or nail-plated. 2. The results were divided into four groups according to the state of the femoral head. In the first group, four heads were histologically viable and had a normal vascular pattern; in the second group, four showed partial avascular necrosis with part of the head retaining a normal blood supply; in the third group, ten had avascular necrosis in all or most of the head and showed little or no revasculanisation; and in the fourth group, seven showed extensive revascularisation of grossly necrotic heads. Total or subtotal capital necrosis had occurred in 64 per cent and total or partial necrosis in 84 per cent of the specimens. The results indicated that interruption of the retinacular vessels was the cause of gross necrosis; and that in most cases an intact blood supply through the ligamentum teres cannot keep more than a part of the head alive when the other vessels are cut off. Occasionally the ligamentum teres is torn by the nail, or though intact, its blood supply is interrupted. This accounts for completion of avascular necrosis in most cases with total capital necrosis. Viability of the subfoveal area from an intact supply through the ligamentum teres was the main source of revascularisation after capital necrosis. Other sources–from across a uniting fracture line, from growth of soft tissue round the head and neck and from other small viable foci in the head and neck–were much less important and the degree of revascularisation was generally limited. Revascularisation was accompanied by fibrocellular invasion of the marrow, differentiation of cells and the formation of oil cysts whereby the necrotic fat is removed; but bony reconstitution was limited. 3. Six fractures were uniting and another had united by bone making an overall union frequency of 50 per cent considering only the nailed fractures older than two weeks. Four of them (57 per cent) showed total or subtotal capital necrosis. In fractures older than two weeks the frequency of union among the eleven nailed fractures with avascular necrosis was 36 per cent, and it was 100 per cent among the three nailed ones with viable or substantially viable heads. Necrosis of the neck side of the fracture was unrelated to non-union because it soon becomes invaded by fibrovascular tissue and new bone. 4. Fibrosis was the basis of union when the head was dead but examination of older fractures at necropsy is needed to assess the long-term results of revascularisation and union. The clinical desirability or otherwise of capital revascularisation after necrosis also needs to be studied

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This study explores the reported rate of surgical site infection (SSI) after hip fracture surgery in published studies concerning patients treated in the UK.

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To evaluate the rate of dislocation following dual mobility total hip arthroplasty (DM-THA) in patients with displaced femoral neck fractures, and to compare rates of dislocation, surgical-site infection, reoperation, and one-year mortality between DM-THA and bipolar hemiarthroplasty (BHA).

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Despite the COVID-19 pandemic, incidence of hip fracture has not changed. Evidence has shown increased mortality rates associated with COVID-19 infection. However, little is known about the outcomes of COVID-19 negative patients in a pandemic environment. In addition, the impact of vitamin D levels on mortality in COVID-19 hip fracture patients has yet to be determined.

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This study sought to compare the rate of deep surgical site infection (SSI), as measured by the Centers for Disease Control and Prevention (CDC) definition, after surgery for a fracture of the hip between patients treated with standard dressings and those treated with incisional negative pressure wound therapy (iNPWT). Secondary objectives included determining the rate of recruitment and willingness to participate in the trial.

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This study aimed to identify patients receiving total hip arthroplasty (THA) for trauma during the peak of the COVID-19 pandemic in the UK and quantify the risks of contracting SARS-CoV-2 virus, the proportion of patients requiring treatment in an intensive care unit (ICU), and rate of complications including mortality.