The treatment of subcapital fractures of the neck of the femur with a nail-plate and wedge osteotomy.

This paper describes the treatment of the more vertical type of subcapital fracture of the neck of tile femur by reduction, nailing, and immediate wedge osteotomv, with fixation by a plate attached to the head of the nail. Ten cases are recorded. As in other clinics, it had been found that the results of treatment, by the standard Smith-Petersen technique, of subcapital fractures of the neck of the femur with a low fracture-shaft angle were poor because many fractures failed to unite. In comparison, fractures with a more horizontal line generally united well after reduction and nailing. It was therefore decided that the type of treatment adopted should depend on tile value of tile fracture-shaft angle, and forty degrees was arbitrarily decided as the dividing line. The importance of the fracture-shaft angle was first recognised by Pauwels (1935). Eyre-Brook and Pridie (1941) measured the angle between the line of fracture and the long axis of the femur and rej)orted that ‘ ‘ this (fracture-shaft) angle clearly outweighs ever ’ other factor and should control tile treatment given.” Per Linton (1944) came to similar conclusions. Thus it is generaliv recognised that the mechanical factors at work in a fracture of the Ileck of the femur are of first importance in obtaining satisfactory union.