[Weight-bearing early after osteosynthesis of the femoral neck by nail-plate (100 cases)].

Abstract

One hundred trochanteric or transcervical fractures, 64 of which were in patients more than 75 years old, were treated by internal fixation with a THS nail-plate. This device is characterised by a better bending strength than a one-piece nail-plate and a design which limits the risk of displacement of the screw in the head so that immediate weight-bearing can be allowed. Weight was borne on the limb in 81 cases at the tenth post-operative day. It did not improve the mortality, there being 17 deaths by the third month but it greatly helped post-operative care and rehabilitation without producing any additional complications. As a result, 43 per cent of patients could return home by the 45th post-operative day and 74 per cent had recovered their previous level of autonomy within three months of operation. There were only four mechanical complications, all in transcervical fractures: one crack fracture in the femoral head and three displacements following inadequate reduction, treated by prosthetic replacement. The follow-up of 80 patients at three months showed that consolidation always developed between the 45th and 90th day with full weight-bearing and a stable radiological picture. There was no intra-articular penetration or bending of the screw and no break-out of the implant. Whilst it is a definite advance in the treatment of trochanteric fractures, a longer follow-up is needed to determine its place compared with prostheses in transcervical fractures.