Treatment options for basicervical fractures of the femoral neck. A clinical follow-up.

Forty basicervical fractures of the femur were treated operatively. Local complications were recorded in 8 cases. In this mostly geriatric group of patients only 18 patients were alive after a mean follow-up of 63 months. Five of the 19 hips showed excellent results. Eight hips were evaluated as poor. No radiological signs of osteonecrosis were observed. Only one nonunion and one delayed union were noted. Surprisingly, the rigid nailplate (ASIF, Jewet) fixation appeared superior to the more up-to-date means of fixation, i.e. the dynamic hip screw. Although the material is limited and heterogenous owing to the relatively few numbers of basicervical fractures in the large entity of the femoral neck fractures in general, this difference was obvious and merits technical consideration. Due to its conical shape the dynamic hip screw is most obviously unstable in rotary stresses, and an additional cancellous screw would probably solve this problem. Some fractures of the series were treated by multiple pins, hemiarthroplasty or Ender nails. The number of cases so treated was small, but still notable for local complications. Thus it remains questionable whether these methods would result in a better response even with more common clinical use, when this special entity of femoral neck fractures is considered.