Abstract
Treatment of fractures of femoral neck by operation is now generally accepted.
Many questions arise, however, especially when the patient is old and, sometimes, debilitated. Among these, two questions appear to be fundamentally important. 1) Is operation more beneficial than conservative means for the patient to survive? 2) Is primary prosthetic replacement for displaced medial fracture always indicated when the patient is old enough?
Literatures are reviewed and our own cases are analysed to get some idea to answer these questions.
The operative intervention for medial fracture is usually less extensive than for lateral (trochanteric) fracture, whereas the conservative treatment for the former is less reliable and needs longer period of recumbancy than for the latter. Hence, medial fractures should almost always be treated by operation. On the other hand, it is sometimes doubtful whether operation is necessarily indicated for lateral fractures. Our statistics on the treatment of lateral fractures show that satisfactory result could be obtained by conservative means provided a meticulous care for general condition of patients is afforded.
Primary prosthetic replacement is now getting increasing popularity in treatment of displaced medial fracture which is notoriously haunted by late complications……nonunion and avascular necrosis. However, it is apparent that the prosthesis cannot be a complete substitute of living bone. The indication for this procedure should more strictly be limited. Old age alone does not appear to justify indiscriminate use of the prosthesis. It seems necessary for us to try to decrease the occurence of late complications rather than to abandon to fix the fracture.
