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Intracapsular Hip #s: Operative management - Simon Richards 16/8/2000

1.Subcapital fracture of the femur

Barnes. JBJS.Feb1976.58B.2-24

Summary : report to MRC of 1503 subcapital fractures, undergoing a variety of internal fixations.

  • Overall 75% united, 25% displaced.
  • Almost all Garden I and II united, 66% Garden III and IV united
  • Union rate decreased if >80yrs, quality of reduction (varus deformity -50%united, ant or post angulation on lateral xray >20 degrees-50% united)

Critique: Different fixation methods

2.ORIF or Hemiarthroplasty for undisplaced fractures of the femoral neck in Octogenarians.

Hui.JBJS.Nov1994.76B.891-894

Summary: Question asked - is ORIF best thing for the elderly with minimally displaced fractures.

  • Outcome - >80 yrs -31% reop rate, 65-79 - 7% reop rate, >80 yrs with a hemiarthroplasty - 7% reop rate

Critique: Low numbers of patients i.e 114

3.Current Concepts Review. Intracapsular fractures of hip.

Swiontkowski.JBJS.Jan1994.76A.129-135

Summary: Pts < 65 yrs with no chronic illness - ORIF with cannulated hip screws.

30% non union, 16% reop rate

  • Pts > 75 yrs - Bipolar Hemiarthroplasty
  • 12% reop rate c.f 16% reop rate with unipolar
  • Pts inbetween - depends on physical state
  • THR - 10% dislocation rate, 10 infection rate, 30% poor results.

Critique: only overview. Little hard data



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