Letters to the Editor   |    
Early and Delayed Fixation of Hip Fractures
M.R. Webb, FRCS(Eng); J.K. Borrill, FRCS(Orth)
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The authors did not receive grants or outside funding in support of their research or preparation of this work. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2003 Nov 01;85(11):2247-2247
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To The Editor:We read with interest the article "Comparison of Early and Delayed Fixation of Subcapital Hip Fractures in Patients Sixty Years of Age or Less" (2002;84:1605-12), by Jain et al. We are concerned by their decision to use twelve hours postinjury as the cutoff between early and delayed treatment. Scientific and clinical work points to a cutoff of six hours postinjury for fixation of intracapsular fractures of the femoral neck in younger patients.In a study of the effects of occlusion of the blood supply to the femoral head in a group of dogs, Woodhouse1 found that, with six hours of anoxia of the femoral head, avascular necrosis subsequently developed in 50% of the femoral heads. However, with twelve hours of anoxia, avascular necrosis developed in 100% of the femoral heads. In a similar study, Rösingh and James2 assessed the survival of bone cells following ischemia in the femoral heads of rabbits. They demonstrated that, at six hours post-ischemia, the DNA of osteocytes and osteoblasts reached the point of no return with subsequent DNA disintegration. Osteoclasts disintegrated at three days.
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