Treatment of Ununited Fractures of the Neck of the Femur
I have previously reported our experience and the results we have secured in the treatment of fresh fractures of the neck of the femur, pointing out the advantages of the use of the Smith-Petersen nail1. At this time I wish to draw attention to two cases of nonunion of the neck of the femur treated by means of bone grafts and the Smith-Petersen nail because they exemplify the excellent results that can be anticipated from this method.
The following is a brief resume of the operation that was used in these two cases.
The neck of the femur was exposed by the usual Smith-Petersen incision, the fracture was explored, and any necessary improvement in position was carried out. A window was made in the front of the neck of the femur (Fig. 1A) to facilitate the curettement and removal of all the scar and fibrous tissue from the fractured ends of the bone. This curettement was carried up into the head of the bone (Fig. 1B). Through this window, the cavity so formed was thoroughly packed with bone chips procured from the tibia or the crest of the ilium (Fig. 1C) and the window was replaced. A guide wire was then inserted as in an acute fracture and when a satisfactory position was obtained and confirmed by roentgen examination, a Smith-Petersen nail was driven over the guide wire and the fracture thoroughly impacted (Fig. 1D).
The results have been so gratifying that I feel confident that the use of grafts. . .