NATURAL COURSE IN NAILED FRACTURES OF THE FEMORAL-NECK - A 5-YEAR PROSPECTIVE INVESTIGATION

For 5 yr following nailing of their cervical hip fractures 40 patients were repeatedly subjected to 85Sr-scintimetry, radiography and clinical examinations. The mean age of the patients was 73 yr (range: 38-93); 13 fractures healed without complications, 22 developed necrosis of the femoral head and 5 showed non-union. Increasing pain during weight-bearing was an early sign of necrosis or non-union, and it was the main indication for secondary arthroplasty. Pain upon weight-bearing was not always incapacitating and 5 patients with necrosis had no complaints at all. The living situation of patients with development of necrosis proved important for the decision as to whether or not a secondary arthroplasty was needed; those who had partners seemed to avoid a secondary procedure. Primary arthroplasty in fracture of the femoral neck should be avoided.