This review suggests that the insertion of a prosthesis in the treatment of fresh femoral-neck fractures is not appreciably more hazardous to the patient than internal fixation. In carefully selected patients it allows more rapid ambulation and a shorter period of hospitalization and postoperative disability.
Concerning the type of prosthesis, although results with the various models are not greatly dissimilar, there is evidence that the metallic long-stem variety is best.
I had expected the anterior type of operative procedure to be much superior; however, there was little difference between the two. The percentage of satisfactory results was greater in patients in whom the posterior approach was used ; but there were fewer complications, a shorter period of hospitalization, and fewer deaths in the first thirty days with the anterior approach.
Repair of the capsule, when possible, is advisable. Although the figures do not show striking differences, there is an indication that the avoidance of postoperative fixation, in addition to early ambulation, results in fewer complications.
The use of a prosthesis may be indicated purely for relief of pains in the severely debilitated patient; for the most part, however, to justify an operation of this magnitude, one prerequisite should be a reasonable chance that the patient may soon again become ambulatory.
There does seem to be a place for the replacement prosthesis in the management of fresh femoral-neck fractures. Since the length of time a prosthesis may be expected to function cannot be determined by this study, we feel that the circumstances in which this procedure is presently indicated are as follows:
1. In the old patient who is a relatively poor risk and in whom it seems likely that only one surgical procedure will be possible.
2. When early ambulation is essential and the condition of the patient makes the use of a walker or crutches unlikely.
3. In patients who have Parkinson's disease or spastic paralysis.
4. When a satisfactory reduction and fixation of the fracture cannot be obtained even by open operation.