Intracapsular femoral neck fractures:: The importance of early reduction and stable osteosynthesis

With reference to five patient samples from the years 1972-1994 the authors have been able to prove that the rate of late femoral head collapse is significantly lower if osteosynthesis is performed within 6 hours of the accident, i.e. in the phase of reversible ischaemia. Emergency treatment also has a favorable systemic effect on elderly patients (not bed-ridden or hospitalized). The costs of a 24-hour service are balanced by the far greater saving due to a decrease in complications. Since 1990 double nailing has been replaced by percutaneous double screw fixation. Early basic principles have been incorporated into today's standard technique. In the first larger group with screw fixations, apart from the advantages (shorter treatment period, lower mortality), an increase in redisplacements was observed. Significant factors were the age of the patient (osteoporosis), the fracture surface (fragments), and the quality of the operative technique. Possible experimental and/or clinically tested methods of increasing stability are described: insertion of three screws or screws with a larger thread diameter, replacement of the detached Adam's arch with a fixed-angle dynamic collo-diaphyseal (DCD) plate. According to a study as part of the European SAHFE project 1997-1998, these have led to a reduction in dislocation rates. The view will be taken that modern, minimally invasive osteosynthesis performed as an emergency treatment and combined with heightened stability is the better option in the treatment of displaced femoral neck fractures in elderly patients.