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NONUNION OF THE NECK OF THE FEMUR: Study of Three Hundred Forty-Seven Cases

NONUNION OF THE NECK OF THE FEMUR: Study of Three Hundred Forty-Seven Cases Abstract IN THIS study 347 cases of nonunion of the neck of the femur seen at the Campbell Clinic from 1918 through 1949 were reviewed. Nonoperative cases as well as operative cases were analyzed. It was thought that a statistical analysis of the nontreatment group would be of value not only from a simple informative standpoint but also as a basis for comparison with the treated group. The cases were classified in four groups on the basis of results: excellent, good, fair, and poor (Table 1). Those classified as excellent or good were considered satisfactory, while cases in the fair and poor groups were considered unsatisfactory. In the fair group partial weight could be borne on the affected limb. However, the hip function was usually limited and painful, and the x-ray findings were generally poor. We were able to classify 277 cases. In 120 cases no treatment was given; in 157 References 1. Colonna, P. C.: A Reconstruction Operation for Old Ununited Fracture of the Femoral Neck , J. Bone & Joint Surg. 19:945-954, 1937. 2. Colonna, P. C.: The Colonna Reconstruction for Ununited Fractures of the Neck of the Femur , J. Bone & Joint Surg. 21:701-709, 1939. 3. L'Episcopo, J. B.: Stabilization of Pathological Dislocation of the Hip in Children , J. Bone & Joint Surg. 18:737-742, 1936. 4. Albee, F. H.: The Kinesiological Lever in Reconstruction Operations on the Hip , J. Bone & Joint Surg. 22:406-412, 1940. 5. Batchelor, J. S.: Excision of the Femoral Head and Neck for Ankylosis and Arthritis of the Hip , Post Grad. M. J. 24:241-248, 1948. 6. Milch, H.: The Pelvic Support Osteotomy , J. Bone & Joint Surg. 23:581-595, 1941. 7. (a) Henderson, M. S.: Present Day Treatment of Ununited Fractures of the Neck of the Femur , Minnesota Med. 23:339-343, 1940 8. (b) Ununited Fracture of the Neck of the Femur Treated by the Aid of Bone Graft , J. Bone & Joint Surg. 22:97-106, 1940. 9. Speed, J. S., and Smith, H.: Trochanteric Osteotomy for Ununited Fractures of the Neck of the Femur , South. M. J. 34:798-806, 1941. 10. Wagner, L. C.: A Plastic Operation for Ununited Fracture of the Hip , Am. J. Surg. 6:801, 1929. 11. Moore, J. R.: Cartilaginous-Cup Arthroplasty in Ununited Fractures of the Neck of the Femur , J. Bone & Joint Surg. 30-A:313-328, 1948. 12. Brackett, E. G.: Fractured Neck of Femur: Operation of Transplantation of Femoral Head to Trochanter , Boston M. & S. J. 192:1118-1120, 1925. 13. Albee, F. H.: Treatment of Ununited Fracture of the Neck of the Femur , Surg., Gynec. & Obst. 49:810-817, 1929. 14. Campbell, W. C.: Ununited Fractures of the Neck of the Femur , South. M. J. 13:585-588, 1920. 15. (a) Henderson, M. S.: Ununited Fractures of the Hip , Surg., Gynec. & Obst. 30:145-146, 1920 16. (b) Ununited Fractures of the Neck of the Femur , West. J. Surg. 43:134-142, 1935 17. (c) Extra-Articular Osteosynthesis for Nonunion of the Neck of the Femur , Arch. Surg. 42:557-565, 1941. 18. Gallie, W. E., and Lewis, F. I.: Ununited Fracture of the Neck of the Femur in the Aged , J. Bone & Joint Surg. 22:76-80, 1940. 19. Henderson.7a Henderson.14b Henderson.14c 20. King, T.: The Closed Operation for Intracapsular Fracture of the Neck of the Femur , Brit. J. Surg. 26:721-748, 1938. 21. Dickson, J. A.: The High Geometric Osteotomy, with Rotation and Bone Graft, for Ununited Fractures of the Neck of the Femur: A Preliminary Report , J. Bone & Joint Surg. 29:1005-1017, 1947 22. Treatment of Ununited Fractures of Neck of Femur , J. A. M. A. 137:1199-1206, 1948.Crossref 23. Ivins, J. C., and Ghormley, R. K.: Brackett Operation for Ununited Fracture of the Neck of the Femur , Surgery 22:819-824, 1947. 24. Magnuson, P. B.: The Repair of Ununited Fracture of the Neck of the Femur , J. A. M. A. 98:1791-1794, 1932Crossref 25. Report of 59 Consecutive Cases of Ununited Fracture of the Neck of the Femur , Surgery 7:763-772, 1940. 26. Twelve cartilage cup arthroplasties have been done at the Campbell Clinic since 1949. In eight of these patients the cup failed to unite with the neck. With this high percentage of failures, we have discontinued the procedure. 27. Blount, W. P.: Blade-Plate Internal Fixation for High Femoral Osteotomies , J. Bone & Joint Surg. 25:319-339, 1943. 28. McMurray, T. P.: Ununited Fractures of the Neck of the Femur , J. Bone & Joint Surg. 18:319-327, 1936. 29. Hermann, O. J.: The McMurray Osteotomy for Nonunited Hip Fractures , New England J. Med. 232:186-189, 1945 30. Ununited Hip Fractures , Hermann New England J. Med. 226:601-605, 1942. 31. Jahss, S. A., and Mintz, B. J.: Transverse Osteotomy in Ununited Fractures of the Femoral Neck , Bull. Hosp. Joint Dis. 2:143-153, 1941. 32. Leadbetter, G. W.: Cervical-Axial Osteotomy of the Femur: A Preliminary Report , J. Bone & Joint Surg. 26:713-720, 1944 33. The Problem of the Fractured Hip , Nebraska M. J. 30:309-313, 1945. 34. Reich, R. S.: Ununited Fracture of the Neck of the Femur Treated by High Oblique Osteotomy , J. Bone & Joint Surg. 23:141-158. 1941. 35. Schumm, H. C.: The Schanz Osteotomy for Fractures of the Neck of the Femur , J. Bone & Joint Surg. 19:955-963, 1937. 36. Gaenslen, F. J.: The Schanz Subtrochanteric Osteotomy for Irreducible Dislocation of the Hip , J. Bone & Joint Surg. 17:76-86, 1935. 37. Summers, J. E.: Fractures of the Hip: Methods of Treatment in Use at the Present Time , Internat. Abstr. Surg. 88:385-387, 1949 38. Surg., Gynec. & Obst. , (May) 1949. 39. There were no cases in this series in which a prosthesis was used for the femoral head; therefore this type of procedure was not included in the original study. Replacement of the femoral head by a prosthesis may be of value in nonunion of the neck of the femur, especially in older patients with degenerative head changes. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png A.M.A. Archives Surgery American Medical Association

NONUNION OF THE NECK OF THE FEMUR: Study of Three Hundred Forty-Seven Cases

A.M.A. Archives Surgery , Volume 65 (1) – Jul 1, 1952

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Publisher
American Medical Association
Copyright
Copyright © 1952 American Medical Association. All Rights Reserved.
ISSN
0096-6908
DOI
10.1001/archsurg.1952.01260020181017
Publisher site
See Article on Publisher Site

Abstract

Abstract IN THIS study 347 cases of nonunion of the neck of the femur seen at the Campbell Clinic from 1918 through 1949 were reviewed. Nonoperative cases as well as operative cases were analyzed. It was thought that a statistical analysis of the nontreatment group would be of value not only from a simple informative standpoint but also as a basis for comparison with the treated group. The cases were classified in four groups on the basis of results: excellent, good, fair, and poor (Table 1). Those classified as excellent or good were considered satisfactory, while cases in the fair and poor groups were considered unsatisfactory. In the fair group partial weight could be borne on the affected limb. However, the hip function was usually limited and painful, and the x-ray findings were generally poor. We were able to classify 277 cases. In 120 cases no treatment was given; in 157 References 1. Colonna, P. C.: A Reconstruction Operation for Old Ununited Fracture of the Femoral Neck , J. Bone & Joint Surg. 19:945-954, 1937. 2. Colonna, P. C.: The Colonna Reconstruction for Ununited Fractures of the Neck of the Femur , J. Bone & Joint Surg. 21:701-709, 1939. 3. L'Episcopo, J. B.: Stabilization of Pathological Dislocation of the Hip in Children , J. Bone & Joint Surg. 18:737-742, 1936. 4. Albee, F. H.: The Kinesiological Lever in Reconstruction Operations on the Hip , J. Bone & Joint Surg. 22:406-412, 1940. 5. Batchelor, J. S.: Excision of the Femoral Head and Neck for Ankylosis and Arthritis of the Hip , Post Grad. M. J. 24:241-248, 1948. 6. Milch, H.: The Pelvic Support Osteotomy , J. Bone & Joint Surg. 23:581-595, 1941. 7. (a) Henderson, M. S.: Present Day Treatment of Ununited Fractures of the Neck of the Femur , Minnesota Med. 23:339-343, 1940 8. (b) Ununited Fracture of the Neck of the Femur Treated by the Aid of Bone Graft , J. Bone & Joint Surg. 22:97-106, 1940. 9. Speed, J. S., and Smith, H.: Trochanteric Osteotomy for Ununited Fractures of the Neck of the Femur , South. M. J. 34:798-806, 1941. 10. Wagner, L. C.: A Plastic Operation for Ununited Fracture of the Hip , Am. J. Surg. 6:801, 1929. 11. Moore, J. R.: Cartilaginous-Cup Arthroplasty in Ununited Fractures of the Neck of the Femur , J. Bone & Joint Surg. 30-A:313-328, 1948. 12. Brackett, E. G.: Fractured Neck of Femur: Operation of Transplantation of Femoral Head to Trochanter , Boston M. & S. J. 192:1118-1120, 1925. 13. Albee, F. H.: Treatment of Ununited Fracture of the Neck of the Femur , Surg., Gynec. & Obst. 49:810-817, 1929. 14. Campbell, W. C.: Ununited Fractures of the Neck of the Femur , South. M. J. 13:585-588, 1920. 15. (a) Henderson, M. S.: Ununited Fractures of the Hip , Surg., Gynec. & Obst. 30:145-146, 1920 16. (b) Ununited Fractures of the Neck of the Femur , West. J. Surg. 43:134-142, 1935 17. (c) Extra-Articular Osteosynthesis for Nonunion of the Neck of the Femur , Arch. Surg. 42:557-565, 1941. 18. Gallie, W. E., and Lewis, F. I.: Ununited Fracture of the Neck of the Femur in the Aged , J. Bone & Joint Surg. 22:76-80, 1940. 19. Henderson.7a Henderson.14b Henderson.14c 20. King, T.: The Closed Operation for Intracapsular Fracture of the Neck of the Femur , Brit. J. Surg. 26:721-748, 1938. 21. Dickson, J. A.: The High Geometric Osteotomy, with Rotation and Bone Graft, for Ununited Fractures of the Neck of the Femur: A Preliminary Report , J. Bone & Joint Surg. 29:1005-1017, 1947 22. Treatment of Ununited Fractures of Neck of Femur , J. A. M. A. 137:1199-1206, 1948.Crossref 23. Ivins, J. C., and Ghormley, R. K.: Brackett Operation for Ununited Fracture of the Neck of the Femur , Surgery 22:819-824, 1947. 24. Magnuson, P. B.: The Repair of Ununited Fracture of the Neck of the Femur , J. A. M. A. 98:1791-1794, 1932Crossref 25. Report of 59 Consecutive Cases of Ununited Fracture of the Neck of the Femur , Surgery 7:763-772, 1940. 26. Twelve cartilage cup arthroplasties have been done at the Campbell Clinic since 1949. In eight of these patients the cup failed to unite with the neck. With this high percentage of failures, we have discontinued the procedure. 27. Blount, W. P.: Blade-Plate Internal Fixation for High Femoral Osteotomies , J. Bone & Joint Surg. 25:319-339, 1943. 28. McMurray, T. P.: Ununited Fractures of the Neck of the Femur , J. Bone & Joint Surg. 18:319-327, 1936. 29. Hermann, O. J.: The McMurray Osteotomy for Nonunited Hip Fractures , New England J. Med. 232:186-189, 1945 30. Ununited Hip Fractures , Hermann New England J. Med. 226:601-605, 1942. 31. Jahss, S. A., and Mintz, B. J.: Transverse Osteotomy in Ununited Fractures of the Femoral Neck , Bull. Hosp. Joint Dis. 2:143-153, 1941. 32. Leadbetter, G. W.: Cervical-Axial Osteotomy of the Femur: A Preliminary Report , J. Bone & Joint Surg. 26:713-720, 1944 33. The Problem of the Fractured Hip , Nebraska M. J. 30:309-313, 1945. 34. Reich, R. S.: Ununited Fracture of the Neck of the Femur Treated by High Oblique Osteotomy , J. Bone & Joint Surg. 23:141-158. 1941. 35. Schumm, H. C.: The Schanz Osteotomy for Fractures of the Neck of the Femur , J. Bone & Joint Surg. 19:955-963, 1937. 36. Gaenslen, F. J.: The Schanz Subtrochanteric Osteotomy for Irreducible Dislocation of the Hip , J. Bone & Joint Surg. 17:76-86, 1935. 37. Summers, J. E.: Fractures of the Hip: Methods of Treatment in Use at the Present Time , Internat. Abstr. Surg. 88:385-387, 1949 38. Surg., Gynec. & Obst. , (May) 1949. 39. There were no cases in this series in which a prosthesis was used for the femoral head; therefore this type of procedure was not included in the original study. Replacement of the femoral head by a prosthesis may be of value in nonunion of the neck of the femur, especially in older patients with degenerative head changes.

Journal

A.M.A. Archives SurgeryAmerican Medical Association

Published: Jul 1, 1952

References

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