Progress in treatment of femoral neck fracture in young adults / 中华创伤骨科杂志

Treatment of femoral neck fracture in young adults is still a challenge. Controversy arises in the topics addressing surgical timing, reduction strategy (open or closed), necessity of joint capsule decompression, implants and fixation methods. However, whatever is adopted, the goal of surgical treatment is to ensure good fracture reduction and fixation for the patient so as to reduce the risks of internal fixation failure, nonunion and femoral head necrosis. In recent years, application of autogenous bone transplantation, femoral neck medial supporting plate and other new techniques has provided new alternative treatments for femoral neck fracture in young adults. This review comments on the surgical timing, reduction strategy, necessity of joint capsule decompression, and choice of surgical approaches and fixation methods in the treatment of femoral neck fracture in young adults.

Lateral decubitus intramedullary nailing for femoral subtrochanteric fractures / 中华创伤骨科杂志

Objective To investigate the efficacy of lateral decubitus intramedullary nailing for treatment of subtrochanteric fractures of the femur.Methods From January 2012 to December 2015,23 patients with simple femoral subtrochanteric fracture were treated at Department of Orthopedic Trauma,Changhai Hospital.They were 15 males and 8 females,aged from 19 to 77 years (average,48.3 years).According to the Seinsheimer classification,there were 6 cases of type ⅡB,8 cases of type ⅡC,6 cases of type Ⅲ A,and 3 cases of type ⅢB.Their injuries were caused by traffic accident in 10 cases,falling from a height in 5 cases,and sprain in 8 cases.All patients were treated by closed reduction and anterograde intrarnedullary nailing at lateral decubitus.Their operative time,bleeding volume,fluoroscopic frequency,fracture healing time,functional recovery and complications were recorded and analyzed.Results Their operative time ranged from 55 to 80 min,averaging 65.7 min;their bleeding volumes ranged from 240 to 420 mL,averaging 304.3 mL;their fluoroscopic frequency ranged from 30 to 60 times,averaging 42.7 times.This cohort was followed up for 12 to 28 months (average,17.9 months).Their fracture healing time ranged from 4 to 10 months,averaging 5.5 months.Nonunion occurred in one patient but was cured by secondary operation.The HSS evaluation at the final follow-ups showed 17 excellent cases and 6 good ones,yielding an excellent to good rate of 100％.All the wounds healed by the first intention.No infection,deep vein thrombosis or implant failure was observed.Conclusion As lateral decubitus intramedullary nailing can achieve satisfactory clinical efficacy for subtrochanteric fractures of the femur,the body position of lateral decubitus may be a good alternative.