[Medial femoral neck fracture--femur head preserving therapeutic concepts]

Abstract

Intracapsular femoral neck fractures of patients younger than 65 should be treated by open or closed reduction and internal fixation with two to four lag screws. Garden I fractures should also be treated by percutaneous screw fixation to prevent a delayed dislocation. If the fracture is dislocated (Garden II-IV) immediate reduction and internal fixation is mandatory to improve the blood flow by "unkinking" of the supporting vessels. The rate of femoral head necrosis is about ten to fifty percent, according to the grade of posttraumatic dislocation. Early stages of total or partial femoral head necrosis can be successfully treated by vascularized cortical bone grafts. In our institute a graft vascularized by the quadratus femoris muscle is preferred. Valgisation osteotomy, alloarthroplasties and arthrodeses in very young people are performed in cases of irreversible total femoral head necrosis.