WEDGE OSTEOTOMY FOR FRESH INTRACAPSULAR FRACTURES OF THE NECK OF THE FEMUR

¹ Department of Orthopaedic Surgery, Jefferson Medical College, Philadelphia

Wedge osteotomy through the neck of the femur is offered as a simple and effective procedure for converting sheering forces at the fracture site into compression forces. Adequate reposition of the fragments and proper nailing may not be sufficient to neutralize the effects of powerful sheering strains. The conversion of sheering forces to impacting forces at the fracture line by placing the head of the femur in a position of valgus favors early union and tends to reduce the incidence of non-union. The lower incidence of aseptic neerosis may be due to the rapid healing process that takes place at the fracture site when the femoral head is placed and fixed in a position of valgus; this process may save many femoral heads when their vascular status is impaired by the injury. It is readily conceivable that such an active reparative process may play a major role in supplying sufficient nutrition to a capital fragment, thereby precluding the sequelae of diminished on occluded blood supply. However, longer follow-up studies are necessary before the final incidence of capital necrosis can be established.

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It is apparent from this study that open reduction does not increase the rate of mortality of the postoperative complications, nor does it increase the incidence of nonunion or aseptic necrosis. Open procedures permit adequate visualization of the fracture site; and a transcervical wedge osteotomy allows reposition of the fragments in the desired alignment without resorting to forceful, damaging manoeuvres.

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