THERE is a widespread assumption on the part of the general public and many medical men that, with the use of internal fixation, the problem of treatment of fractures of the neck of the femur has been completely and successfully solved. This method of management has marked an important milestone, but it has not provided the complete and final solution in such fractures. Before internal nailing was used, union occurred in only about 50 per cent of intracapsular fractures of the femur, whereas now about 80 per cent of such fractures unite. However, appraisal of results merely from the standpoint of bone healing does not tell the whole story. When the results are considered from the standpoint of function they are unsatisfactory in a rather large proportion of cases in which union is obtained. The group in which atrophic changes in the head and arthritic complications result even though union occurs, added to the approximately 20 per cent of cases in which the fracture fails to unite, comprises about 35 to 50 per cent of all fractures of the femoral neck. Thus treatment with internal fixation may be said to be actually successful in only one-half to two-thirds of such cases. These figures indicate that there is room for considerable improvement in the treatment of this type of fracture.
Until very recently it has been generally thought that the outcome of treatment of a fracture at the neck of the femur depended solely on the degree of interruption of the. . .