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KMID : 0378019690120010052
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New Medical Journal
1969 Volume.12 No. 1 p.52 ~ p.64
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The Clinical Effects in the Treatment of Hip Fractures by Rigid Nail Fixation and functuion Telescoping Massie nail Plate Fixation
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Abstract
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With the clinical investigation and experience functional teloscoping Massie Nail-Plate fixation has made great development in the treatment of hip fractures.
In the technique of fixation, it is important to keep had in valgus position, to insert the nail along the calcar femorale, and to insert it posterior to the-midline in the lateral plane, Since all of the proximal fragments fall off posteriorly. To obtain Union only absolute IMMOBILIZATION at the time of surgery is important. One cannot get impaction Iater by allowing the patient to bear partial or full weight. The Impaction must be done at surgery. Under these conditions does not matter whether the fracture is of low angle (Pauwel´s Type 1) or high angle (Pauwel´s Type 3). But undisplaced fractures do not require impaction as do the displaced fractures. It is necessary to separate the fragment in appling the nail and I think this injury the blood supply. Therefore in this case multiple pinning is more reasonable and practical.
UNION Of VIABLE fragments should result after every fixation. but Avascular necrosis is a rather common complication. It is now my opinion that every fracture of the neck, both displaced and undisplaced, sustain serious vascular damage. The better the initial immobilization and the quicker it is applied (treat all intracapsular fractures as an emergency), the better the chance for good vascularity. I also feel that the blood supply to the proximal fragment improves with time AFTER healing. Hence a person, under 60 years, should not be allowed full unsupported weight bearing for a year. The older patients I allow to to%eight- bearing not because it is good for them, but because they probably tivill not live long enough to get the arthritis which comes on subsequent to early weight-bearing on a partially vascularized flip. To repeat in another wav-it is important to consider every intracapsular fracture as seriously impaired vascularly. The sooner weight bearing is permitted the more chance for subsequent Avascular necrosis or arthritis (which is merely alocalized avascular necrosis.) I like for every fracture to use a cane when he begins weight-bearing for at least 6 months. AVASCULAR NECROSIS is prime complication of this fracture, and it cannot routinely be prevented, but it´s serious incidence can certainly be reduced by the care given the patient.
Recently I had 10 cases of rigid hip nailing (Only Smith petersen´s nail and plate was available) in small civilian clinics with jnly a single X-Ray machine under poor facilities and on the ordinary general operating table (not as in the Orthopaedic fracture table).
There are more practical difficulties in this procedure, particulary the manipulation of proximal fragment in valgus, insertion of the rigid nail along the calcar femorale, and impaction at the time of surgery, I am trying to get clinical results from these procedure, However I realized rigid hip nailing was not functional fixation and a practical procedure.
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