Transarticular Nailing for Fractures of the Femoral Neck. a Preliminary Report.

Research on avascular necrosis, creeping substitution, mechanics and circulation in relation to the femoral head has led to a better understanding of fracture at the hip. Despite this better knowledge, it has been impossible to solve the problem of the high incidence of avascular necrosis and pseudarthrosis. It seems that a deeper comprehension of the hip problem has given us a “ defeatist attitude “ (Dickson 1953) in the matter ofthese complications to the extent of forsaking osteosynthesis and sacrificing the femoral head for a prosthesis. However, advances such as improvement of fixation material and surgical techniques have diminished the incidence of complications. Undoubtedly, the overreduced position (McElvenny 1957) by preventing shearing stresses at the fracture site and by fixing of the femoral head in valgus contributes to the attainment of osseous union. This is especially so if, with diaphysial fixation, the nail penetrates deeply and rests on the calcar femoralis. One would not easily recognise in transarticular nailing a basis for a contribution to the solution of the problem, because the procedure is insulting both to the joint and to the mind. Nevertheless, many transarticular fixations have been done because of technical error, and were often followed by bony union (Eaton 1956). We now believe that this unorthodox procedure might well have some advantages. It is presented as an alternative technique to replacement by prosthesis for use in the aged.