Poor results following internal fixation of displaced subcapital femoral fractures: complacency in fracture reduction

The results following internal fixation of displaced subcapital femoral fractures are poorer than for undisplaced fractures and are determined by both the quality of the initial reduction and the accuracy of implant placement. In a series of 26 consecutive displaced fractures internally fixed with Richards hip pins, satisfactory reduction was achieved in only 15 hips. Accurate reduction is a prerequisite for correct screw placement and occurred in only 4 of the 11 poorly aligned fractures, as opposed to 11 of the 15 well reduced ones. A total of 10 hips required a further surgical procedure as the result of complications. These results highlight the importance of accurate fracture reduction in facilitating implant placement as well as the importance of good surgical technique rather than reliance purely upon the implant. These already common fractures are assuming increasing socioeconomic importance as the elderly population grows, and successful management is vital for both the individual patient and future demands on the health service.