[Femoral head preserving therapy in medial femoral neck fractures. A clinical study of the effects of treatment method on the outcome].

The main problem with fractures of the femoral neck is the high incidence of avascular necrosis and non-union. While the rate of pseudarthroses has been lowered by treatment with stable compression screws, no effect of this technique on the incidence of head necrosis is evident. The reasons for this are rupture of vessels, wide dislocation of fragments and diminution of blood supply owing to intracapsular hematoma. Since 1982 we have been using a defined indications and therapy schedule for these fractures, which is based on the main principle of open operative treatment in younger patients. This procedure is the only one that makes accurate reduction and stable internal fixation of fragments possible. With the opening of the capsule and evacuation of the hematoma pressure on the blood vessels is relieved. The analysis of data recorded in 81 patients treated with open reduction and stable internal fixation revealed that poor functional results and avascular necrosis occur especially in fractures of Garden's stages III and IV that are operated on longer than 6 h after the trauma is sustained. Therefore, the operation should be performed as soon as possible as an emergency procedure to reduce the likelihood of such severe complications.