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• W2096080176 abstract "The Journal of Bone and Joint Surgery. British volumeVol. 87-B, No. 11 CorrespondenceFree AccessThe complications of displaced intracapsular fractures of the hipM. TODKARM. TODKARSearch for more papers by this authorPublished Online:1 Nov 2005https://doi.org/10.1302/0301-620X.87B11.17089AboutSectionsPDF/EPUB ToolsDownload CitationsTrack CitationsPermissionsAdd to Favourites ShareShare onFacebookTwitterLinked InRedditEmail Sir,I read with great interest the article by Gurusamy, Parker and Rowlands1 in the May 2005 issue entitled ‘The complications of displaced intracapsular fractures of the hip’.In this study, the only factor the authors considered for cases of nonunion was the position of cannulated screws on radiographs. The rate of nonunion was approximately 39% in this series. However, it is well established that a number of other factors are also responsible for nonunion, for example comminution at the fracture site, osteoporosis, physiological age of the patient, apex-tip distance of screws, and delay between fracture and fixation.2 None of these factors was considered in this study.The authors stated that they felt that mechanical failure of fixation should be blamed for most nonunions, which is a generalisation. In fact, in most cases of nonunion implant failure is secondary to biological failure.Their other conclusion is that the degree of angulation between the screws had no measurable effect on the risk of nonunion. It is well known that collapse at the fracture site will not occur unless the screws are parallel.3,4 Lack of parallelism between the screws was one of the important factors in the failure of Gardens screws placed at 90° used for fixation of these fractures.5 References 1 Gurusamy K, Parker MJ, Rowlands TK. The complications of displaced intracapsular fractures of the hip. J Bone Joint Surg [Br] 2005;87-B:632–4. Link, Google Scholar2 Parker MJ. Prediction of fracture union after internal fixation of intracapsular femoral neck fractures: related articles. Injury 1994;25 (Suppl 2):3–6. Crossref, ISI, Google Scholar3 Rehnberg L, Olerud C. Fixation of femoral neck fractures: comparison of Uppsala and Von Bahr screws. Acta Orthop Scand 1989;60:579–84. Crossref, Medline, Google Scholar4 Lagerby M, Asplund S, Ringqvist I. Cannulated screws for fixation of femoral neck fractures: no difference between Uppsala and Richards screws in a randomized prospective study of 268 cases. Acta Orthop Scand 1998;69:387–91. Crossref, Medline, Google Scholar5 Parker MJ, Porter KM, Eastwood DM, Schembi Wismayer M, Bernard AA. Intracapsular fractures of the neck of femur: parallel or crossed garden screws? J Bone Joint Surg [Br] 1991;73-B:826–7. Link, Google ScholarFiguresReferencesRelatedDetailsCited ByFinite element analysis of new headless compression supporting screw for the treatment of unstable femoral neck fractureBio-Medical Materials and Engineering, Vol. 33 Vol. 87-B, No. 11 Metrics History Published online 1 November 2005 Published in print 1 November 2005 InformationCopyright © 2005, The British Editorial Society of Bone and Joint Surgery: All rights reservedPDF download" @default.
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• W2096080176 title "The complications of displaced intracapsular fractures of the hip" @default.
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