Impacted fixation over resilient multiple pins.
Fractures of the neck of the femur require prompt treatment and an anatomic or translated reduction on the fracture table with traction applied parallel with the body. Valgus position is not satisfactory. The plate and minimum of nine pins, by hammer impaction at surgery, coapts the irregular surfaces. Strain-gauge studies showed that only 25% of the stress on the fracture site is borne by a "tell-tale" nail. Seventy-five percent of the stress is dissipated by the surrounding bone. It is essential to immediately secure the 75% support of the surrounding bone by impaction at surgery and by recording the degree of impaction on the chart. To accept shortening or collapse over the first six to eight weeks means six to eight weeks of secondary healing going through a cartilage phase instead of healing per primam. Avascular necrosis, if it occurs, will not manifest itself until six months later. In this period the fracture site is vulnerable to nonunion. One must promote primary endosteal bone healing with no cartilage and no motion at fracture site. Resilient fixation dissipates the forces tending to displace the fracture, yet holds it with sufficient rigidity to promote early prompt union, typically within nine weeks. Secure plate-stabilized properly applied fixation allows full weight-bearing on the third to fourth postoperative day.
D001696:Biomechanical Phenomena; D001858:Bone Nails; D002358:Cartilage, Articular; D005271:Femur Head Necrosis / Q000209:etiology; D005272:Femur Neck / Q000601:surgery; D006620:Hip Fractures / Q000503:physiopathology / Q000601:surgery*; D006621:Hip Joint / Q000098:blood supply; D006801:Humans; D009038:Motion; D011183:Postoperative Complications; D011312:Pressure; D013997:Time Factors; D014945:Wound Healing