Nailing versus prosthesis for femoral neck fractures. A critical review of long term results in two hundred and thirty nine consecutive private patients

In a follow up study of 239 consecutive patients with fractures of the femoral neck treated by 6 surgeons by Pugh nailing, Austin Moore prosthesis, or Knowles pinning, 96% could be followed for a minimum of 2 years or until a definitive result had been reached. The incidence of unsatisfactory results was 39.3% after Pugh nailing, 18.2% after prosthetic replacement, and 14.2% after Knowles pinning (mostly undisplaced or impacted fractures). Thirty five unsatisfactory results following Pugh nailing were due to: aseptic necrosis which was definite in eighteen cases and probable in two; early mechanical failure in twelve cases; infection in one; and late non union in two. Eight poor results followed prosthetic replacement and were due to erosion of the acetabulum in six and dislocation in two. The 4 poor results that followed Knowles pinning were due to aseptic necrosis in 3 and to pain, probably the result of aseptic necrosis, in another. From this study it was concluded that aseptic necrosis was more influenced by the original displacement than by the accuracy of reduction or fixation, and that in displaced femoral neck fractures in the elderly, prosthetic replacement gave a more reliable result.