Natural course in nailed fractures of the femoral neck. A five-year prospective investigation.

For 5 years following nailing of their cervical hip fractures 40 patients were repeatedly subjected to 85Sr-scintimetry, radiography, and clinical examinations. The mean age of the patients was 73 years (range: 38-93); 13 fractures healed without complications, 22 developed necrosis of the femoral head, and five showed non-union. Increasing pain during weight-bearing was an early sign of necrosis or nonunion, and it was the main indication for secondary arthroplasty. However, pain upon weight-bearing was not always incapacitating, and five patients with necrosis had no complaints at all. The living situation of patients with development of necrosis proved important for the decision as to whether or not a secondary arthroplasty was needed; those who had partners seemed to avoid a secondary procedure. It is concluded that primary arthroplasty in fracture of the femoral neck should be avoided.