Early or delayed weight-bearing after internal fixation of transcervical fracture of the femur. A clinical trial.

Since the introduction of the trifin nail in the treatment of femoral neck fractures in 1931 (Smith-Petersen, Cave and Vangorder 1931) there has been controversy about the time at which unguarded weight-bearing may be safely started after operation. The patients described by Smith-Petersen and his colleagues were allowed to walk in a plaster hip spica three weeks after operation, although free weight-bearing was deferred until there was radiological evidence of union of the fracture. Moore (1937), whose original intention had been to delay weight-bearing until the fracture was united, found that patients who disregarded instructions and walked soon after the operation with the injured hip unprotected fared as well as the others, and he altered his r#{233}gime accordingly. In contrast, King (1939) reported an increased incidence of poor results when full weight-bearing was allowed before union of the fracture. Even the introduction of new appliances for internal fixation of the fracture has not helped to resolve the argument. Jewett, Albee, Powers and Stanford (1952) and Pugh (1955), reporting the results after the use of their nail-plates, advised the avoidance of full weightbearing on the limb until the fracture was united, whereas Garden (1961) and Smyth, Ellis, Manifold and Dewey (1964) encouraged walking soon after operation. The latter workers, in fact, succeeded in obtaining union in thirty-eight of forty-five patients treated by their triangle pinning method, results which compare well with any comparable series. It is clearly of great advantage if patients with a transcervical fracture of the femur are allowed to walk soon after operation. The hazards of prolonged bed rest or prolonged reduction in activity are avoided, as is crutch walking, a difficult and often impossible task for the elderly. There is also a great economy of hospital beds. In an attempt to answer the question of whether or not early weight-bearing is injurious, a trial was initiated in 1961 at the Western Infirmary, Glasgow, in which the results of early and late weight-bearing were compared in patients with femoral neck fractures treated by one method of internal fixation. A preliminary report on this trial by Abrami and Stevens (1964) showed that at six months after operation there was no increase in the failure of fixation with early weight-bearing. This paper reports the results three years after operation.