Treatment of Central or Intracapsular Fractures of the Neck of the Femur

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In discussing fractures of the upper end of the femur, it is very important to differentiate between intertrochanteric fractures and central or intracapsular fractures of the neck of the femur. In many of the large series of cases of fractures of the neck of the femur that have been reported, it has been shown that approximately 40 to 45 per cent are central fractures and that 55 to 60 per cent are intertrochanteric fractures. In intertrochanteric fractures, bony union may be expected if approximate anatomic apposition is maintained by casts or various forms of traction. In the central fractures of the neck of the femur, there has in the past been much doubt about securing osseous union. It is about the treatment of this group that I wish to direct my remarks.

Prior to 1904, it was considered that central or intracapsular fractures would not unite by osseous union, it being assumed that this type of fracture was essentially an attribute of old age. Stimson in his “Practical Treatise on Fractures and Dislocations” in 1910, stated “restoration of function is rarely to be attempted or even sought,” and Pye in his book called “Surgical Handicraft” stated “the patient should be propped up in bed with the limb between sand bags. After about a month, the patient should be encouraged to use the leg as much as possible since union is not aimed at.”

In 1904, Doctor Royal Whitman first described the abduction method of reduction and fixation by use of. . .



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