INTRACAPSULAR FRACTURES OF THE FEMUR TREATED WITH A COMBINED SMITH-PETERSEN NAIL AND FIBULAR GRAFT

¹ Orthopaedic Department, Glasgour Royal Infirmary

In the treatment of intracapsular fractures, the use of a fibular graft with a trifin nail does not increase the mortality, and the addition of the graft lengthens the operation time by only a few minutes.

In this small series of cases a much higher proportion of bony union occurred (87 percent.) and fewer cases of aseptic necrosis appeared (9 per cent.) as compared with the published results of cases treated with a nail alone. The true figure for aseptic necrosis, however, can only be assessed after a clinical and roentgenographic follow-up of all the cases for a number of years; and the author's series of cases is too small to draw any hard-and-fast Conclusions on this aspect of the condition.

In one patient, necrosis developed in spite of seventeen months of non-weight-bearing. It is evident that non-weight-bearing does not prevent necrosis, although, of course, it may minimize collapse of the head and be of some value in delaying the onset of osteoarthritis. Early weight-bearing may result in further impaction and shortening of the neck and this may cause the graft to penetrate the joint. For this reason weight-bearing should be avoided for the first three months, and the fibular graft should be inserted a little less than the depth of the trifin nail.

The results in this small series of cases would seem to justify the use of a combined nail and fibular graft in all intracapsular fractures of the femur.

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