Alternative techniques in trochanteric hip fracture surgery: Clinical and biomechanical studies on the Medoff sliding plate and the Twin hook

In allowing compression along the femoral shaft (uniaxial dynamization) and optional compression along the femoral neck (biaxial dynamization), the Medoff sliding plate (MSP) represents a new principle in the fixation of trochanteric hip fractures. The Twin hook with 2 apical hooks was designed as an alternative to the lag screw. In 3 prospective consecutive case series and 1 prospective randomized study together comprising 342 trochanteric fractures, these alternative techniques were investigated. 3 postoperative fixation failures occurred in the unstable intertrochanteric fractures treated with biaxial dynamization with the MSP (n=194), and 5 in those treated with the sliding hip screw (n=62) (p=0.04). A mean femoral shortening of 15 mm with the MSP and 11 mm with the sliding hip screw was found (p=0.03). More medialization of the femoral shaft occurred with the sliding hip screw (26%) than with the MSP (12%) in patients with marked femoral shortening (p=0.03). 3 postoperative fixation failures occurred in subtrochanteric fractures treated with uniaxial dynamization (n=29) and 2 in those treated with biaxial dynamization (n=19). Medialization of the femoral shaft occurred in 9 of the 19 biaxially dynamized fractures. The Twin hook was used in 50 patients and appeared to provide similar fixation stability as the lag screw. Biomechanical tests confirmed improved stress transmission over the fracture area with the MSP compared to the sliding hip screw in intertrochanteric fractures, and similar fixation stability with the MSP and the Intramedullary Hip Screw in subtrochanteric fractures. In axial and torsional loading, the Twin hook demonstrated gradually increasing resistance to migration. With the lag screw, the peak load was higher, but after migration with failure of the support by the threads, the loads were similar. Biaxial dynamization with the MSP appears to control fracture impaction effectively and minimizes the rate of postoperative fixation failure in intertrochanteric fractures. In subtrochanteric fractures, uniaxial dynamization prevents medialization of the femoral shaft and is therefore preferred to biaxial dynamization. The Twin hook appears to provide adequate fixation stability, and with potential for simplified intraoperative handling and reduced dissection, the Twin hook may pose advantages compared to the lag screw.     

Low reoperation rate with the Medoff sliding plate: 1 technical failure in 63 trochanteric hip fractures

The Medoff sliding plate was designed to treat unstable intertrochanteric and subtrochanteric fractures. This plate has a dual sliding capability along both the femoral shaft and neck in order to improve bone coaptation, interfragment compression and hence load-sharing between bone and implant in hip fractures. In a retrospective study of 63 patients (mean age 82 (51-98) years) with intertrochanteric (n 44) and high subtrochanteric fractures (n 19), we assessed the results with the Medoff sliding plate. All patients, except 1 lost to follow-up, were examined clinically and radiographically. 14 patients died within 1 year, and in the other, the mean follow-up was 15 (6-30) months. 1 technical failure occurred, leading to a single reoperation. The low technical failure rate suggests that the Medoff sliding plate with combined compression modus is suitable for treating intertrochanteric and high subtrochanteric fractures.     

Low reoperation rate with the Medoff sliding plate: 1 technical failure in 63 trochanteric hip fractures

The Medoff sliding plate was designed to treat unstable intertrochanteric and subtrochanteric fractures. This plate has a dual sliding capability along both the femoral shaft and neck in order to improve bone coaptation, interfragment compression and hence load-sharing between bone and implant in hip fractures. In a retrospective study of 63 patients (mean age 82 (51-98) years) with intertrochanteric (n 44) and high subtrochanteric fractures (n 19), we assessed the results with the Medoff sliding plate. All patients, except 1 lost to follow-up, were examined clinically and radiographically. 14 patients died within 1 year, and in the other, the mean follow-up was 15 (6-30) months. 1 technical failure occurred, leading to a single reoperation. The low technical failure rate suggests that the Medoff sliding plate with combined compression modus is suitable for treating intertrochanteric and high subtrochanteric fractures.     

Low reoperation rate with the Medoff sliding plate: 1 technical failure in 63 trochanteric hip fractures

The Medoff sliding plate was designed to treat unstable intertrochanteric and subtrochanteric fractures. This plate has a dual sliding capability along both the femoral shaft and neck in order to improve bone coaptation, interfragment compression and hence load-sharing between bone and implant in hip fractures. In a retrospective study of 63 patients (mean age 82 (51-98) years) with intertrochanteric (n 44) and high subtrochanteric fractures (n 19), we assessed the results with the Medoff sliding plate. All patients, except 1 lost to follow-up, were examined clinically and radiographically. 14 patients died within 1 year, and in the other, the mean follow-up was 15 (6-30) months. 1 technical failure occurred, leading to a single reoperation. The low technical failure rate suggests that the Medoff sliding plate with combined compression modus is suitable for treating intertrochanteric and high subtrochanteric fractures.     

Extramedullary fixation of 569 unstable intertrochanteric fractures: A randomized multicenter trial of the Medoff sliding plate versus three other screw-plate systems

We compared the efficacy of the Medoff sliding plate (MSP) with 3 other screw-plate systems for fixation of unstable intertrochanteric fractures in a randomized multicenter trial of 569 elderly patients. The MSP has biaxial dynamic capacity along both the neck and the shaft of the femur unlike the other systems, which lack dynamic capacity along the shaft. 268 fractures were operated on with the MSP, and 301 with the dynamic hip screw (DHS), with or without a trochanteric stabilizing plate (DHS/TSP) or with the dynamic condylar screw (DCS). The MSP had recently been shown to the surgeons.The patients in the groups were similar as regards age, domestic situation, preinjury walking ability and type of fracture. We followed the patients clinically and radiographically for at least 1 year. There was no significant difference in walking ability at follow-up or rate of return to home. Fixation failure occurred in 18/268 fractures operated on with the MSP, in 8/238 with the DHS, in 3/49 with the DHS/TSP and in 1/14 with the DCS. The difference in the rate of fixation failure was not statistically significant when the MSP group was compared to the 3 other groups. In 14 of the 18 fixation failures in the MSP group, the biaxial dynamic capacity of the MSP had not been used due to technical errors by surgeons, unfamiliar with the new method. No selection bias was found regarding fracture types in the 2 subgroups of patients with correct or inadequate biaxial dynamization. Extramedullary fixation of unstable intertrochanteric fractures with these implants showed a low failure rate. When using the MSP, biaxial dynamization must be correctly performed.     

Extramedullary fixation of 569 unstable intertrochanteric fractures: a randomized multicenter trial of the Medoff sliding plate versus three other screw-plate systems

We compared the efficacy of the Medoff sliding plate (MSP) with 3 other screw-plate systems for fixation of unstable intertrochanteric fractures in a randomized multicenter trial of 569 elderly patients. The MSP has biaxial dynamic capacity along both the neck and the shaft of the femur unlike the other systems, which lack dynamic capacity along the shaft. 268 fractures were operated on with the MSP, and 301 with the dynamic hip screw (DHS), with or without a trochanteric stabilizing plate (DHS/TSP) or with the dynamic condylar screw (DCS). The MSP had recently been shown to the surgeons.The patients in the groups were similar as regards age, domestic situation, preinjury walking ability and type of fracture. We followed the patients clinically and radiographically for at least 1 year. There was no significant difference in walking ability at follow-up or rate of return to home. Fixation failure occurred in 18/268 fractures operated on with the MSP, in 8/238 with the DHS, in 3/49 with the DHS/TSP and in 1/14 with the DCS. The difference in the rate of fixation failure was not statistically significant when the MSP group was compared to the 3 other groups. In 14 of the 18 fixation failures in the MSP group, the biaxial dynamic capacity of the MSP had not been used due to technical errors by surgeons, unfamiliar with the new method. No selection bias was found regarding fracture types in the 2 subgroups of patients with correct or inadequate biaxial dynamization. Extramedullary fixation of unstable intertrochanteric fractures with these implants showed a low failure rate. When using the MSP, biaxial dynamization must be correctly performed.     

Extramedullary fixation of 569 unstable intertrochanteric fractures: A randomized multicenter trial of the Medoff sliding plate versus three other screw-plate systems

We compared the efficacy of the Medoff sliding plate (MSP) with 3 other screw-plate systems for fixation of unstable intertrochanteric fractures in a randomized multicenter trial of 569 elderly patients. The MSP has biaxial dynamic capacity along both the neck and the shaft of the femur unlike the other systems, which lack dynamic capacity along the shaft. 268 fractures were operated on with the MSP, and 301 with the dynamic hip screw (DHS), with or without a trochanteric stabilizing plate (DHS/TSP) or with the dynamic condylar screw (DCS). The MSP had recently been shown to the surgeons.The patients in the groups were similar as regards age, domestic situation, preinjury walking ability and type of fracture. We followed the patients clinically and radiographically for at least 1 year. There was no significant difference in walking ability at follow-up or rate of return to home. Fixation failure occurred in 18/268 fractures operated on with the MSP, in 8/238 with the DHS, in 3/49 with the DHS/TSP and in 1/14 with the DCS. The difference in the rate of fixation failure was not statistically significant when the MSP group was compared to the 3 other groups. In 14 of the 18 fixation failures in the MSP group, the biaxial dynamic capacity of the MSP had not been used due to technical errors by surgeons, unfamiliar with the new method. No selection bias was found regarding fracture types in the 2 subgroups of patients with correct or inadequate biaxial dynamization. Extramedullary fixation of unstable intertrochanteric fractures with these implants showed a low failure rate. When using the MSP, biaxial dynamization must be correctly performed.     

The Medoff sliding plate and a standard sliding hip screw for unstable intertrochanteric fractures: A mechanical comparison in cadaver femurs

The Medoff sliding plate has a dual side capability along both the femoral shaft and neck to increase theoretically interfragmentary compression and load-sharing in hip fractures. We studied intertrochanteric fracture fixation in cadaveric bone to determine whether this device has a mechanical advantage over a standard sliding hip screw.

2-part and 4-part fractures were created in 12 cadaver femurs. The fractures were fixated and sequentially destabilized; bone and plate strains and fragment displacements were determined during testing, as a function of applied physiological loads before and after short-term cycling.

The Medoff sliding plate imposed a higher mean medial cortex strain than the sliding hip screw in all fracture models and at all loading levels, and the difference was statistically significant in the 2-part and in the unstable 4-part fracture models. The loading of the medial cortex region after cycling was approximately 50% higher in the Medoff samples than in the sliding hip screw samples. There were no significant differences in plate strains, fracture displacements or load to failure between the 2 devices.

These observations favor the dual sliding principle as regards providing fracture compression and load-sharing, which may explain low failure rates in clinical series of unstable intertrochanteric fractures, treated with the Medoff sliding plate.     

Femoral shortening in intertrochanteric fractures. A comparison between the Medoff sliding plate and the compression hip screw

We compared 54 patients treated by a Medoff sliding plate (MSP) with 60 stabilised by a compression hip screw (CHS) in a prospective, randomised study of the management of intertrochanteric femoral fractures. Four months after the operation femoral shortening was determined from radiographs of both femora. In unstable fractures the mean femoral shortening was 15 mm with the MSP and 11 mm with the CHS (p = 0.03). A subgroup in which shortening was classified as large, comprising one-third of the patients in each group, had a similar extent of shortening, but more medialisation of the femoral shaft occurred in the CHS (26%) than in the MSP (12%) group (p = 0.03). Five postoperative failures of fixation occurred with the CHS and none with the MSP (p = 0.03). The marginally greater femoral shortening seen with the MSP compared with the CHS appeared to be justified by the improved control of impaction of the fracture. Biaxial dynamisation in unstable intertrochanteric fractures is a safe principle of treatment, which minimises the rate of postoperative failure of fixation.     

A new device for the fixation of unstable pertrochanteric fractures of the hip

A new type of fixation device for the treatment of pertrochanteric fractures of the hip is described. The device has an axial-compression screw to allow compression along an axis parallel to the femoral shaft. As the fracture settles postoperatively, dynamic axial compression continues. This axial-compression device was used in twenty-five patients who had an unstable intertrochanteric or proximal subtrochanteric fracture of the proximal part of the femur. The average extent of axial impaction or settling was five millimeters (standard deviation, 1.3 millimeters) at the most recent follow-up examination, and the relationship between the femoral head and shaft was altered less than with the use of a conventional compression screw-plate device. A larger proportion of the patients who had the new device were able to walk fifteen meters (fifty feet) independently by the time of discharge from the hospital, even though they left the hospital earlier. No technical failures were seen in the patients who were treated with the axial-compression screw device. We believe that the axial-compression screw-plate device is appropriate for the treatment of unstable pertrochanteric fractures of the hip.     

Prospective randomized controlled trial of an intramedullary nail versus dynamic screw and plate for intertrochanteric fractures of the femur

OBJECTIVES: To compare the surgical complications and functional outcome of the Gamma nail intramedullary fixation device versus the Richards sliding hip screw and plate device in intertrochanteric femoral fractures. DESIGN: A prospective, randomised controlled clinical trial with observer blinding. SETTING: A regional teaching hospital in the United Kingdom. PATIENTS: All patients admitted from the local population with intertrochanteric fractured femurs were included. There were 400 patients entered into the study and 399 followed-up to one year or death. INTERVENTION: The devices were assigned by randomization to either a short-type Gamma nail (203 patients) or a Richard's-type sliding hip screw and plate (197 patients). MAIN OUTCOME MEASUREMENTS: The main surgical outcome measurements were fixation failure and reoperation. A functional outcome of pain, mobility status, and range of movement were assessed until one year. RESULTS: The requirement for revision in the Gamma nail group was twelve (6%); for Richard's group, eight (4%). This was not statistically different (p = 0.29; odds ratio, 1.48 [0.59-3.7]). A subcapital femoral fracture occurred in the Richard's group. Femoral shaft fractures occurred with four in the Gamma nail group (2%) and none in the Richard's group (p = 0.13). Three required revision to another implant. Lag-screw cut-out occurred in eight patients in the gamma nail group (4%) and four in the Richard's group (2%). This was not statistically significant (p = 0.37; odds ratio, 2.29 [0.6-9.0]). The development of other postoperative complications was the same in both groups. There was no difference between the two groups in terms of early or long-term functional status at one year. CONCLUSIONS: The use of an intramedullary device in the treatment of intertrochanteric femoral fractures is still associated with a higher but nonsignificant risk of postoperative complications. Routine use of the Gamma nail in this type of fracture cannot be recommended over the current standard treatment of dynamic hip screw and plate.     

Comparison of a sliding hip screw with a trochanteric lateral support plate to an intramedullary hip screw for fixation of unstable intertrochanteric hip fractures: a cadaver study

BACKGROUND: The lateral trochanteric support plate (LSP) was developed to prevent excessive sliding of unstable intertrochanteric femur fractures fixed with a sliding hip screw (SHS). This study compared the fracture stability and screw sliding characteristics of unstable intertrochanteric femur fractures fixed with either an SHS and LSP or an Intramedullary Hip Screw (IMHS). METHODS: Six matched pairs of cadaveric human femurs with simulated, unstable intertrochanteric femur fractures were stabilized with either an IMHS or a 135-degree SHS with an attached LSP. Inferior and lateral head displacements and lag screw sliding distances were measured for applied static loads of 750 N, before and after cycling. RESULTS: Four-part unstable intertrochanteric femur fractures showed comparable screw sliding characteristics and stability whether instrumented with an SHS and LSP or an IMHS. CONCLUSION: A sliding hip screw with an attached lateral support plate provides stability and ability to resist medial displacement of the femoral shaft similar to that seen with the IMHS.     

Operative treatment of hip fractures in patients receiving hemodialysis

Fifteen hips in 13 patients with hip fracture were treated in patients receiving hemodialysis for chronic renal failure. There were four intertrochanteric and 11 femoral neck fractures. 10 of the 11 femoral neck fractures and one of the four intertrochanteric fractures were treated with cemented bipolar hemiarthroplasty. Two intertrochanteric fractures fixed with sliding compression screws. External fixation was used for stabilization in two patients who had femoral neck and intertrochanteric fractures. Two intertrochanteric fractures that were treated with sliding hip screw showed radiological union postoperatively at the 6th month. Of the 11 hemiarthroplasty, four hips developed aseptic loosening (36%). According to Harris hip score grading system, three (37.5%) poor, two (25%) fair, two (25%) good and one (12.5%) case had excellent outcome in the hemiarthroplasty group. The survival of dialysis patients with a hip fracture is markedly reduced. Initial treatment of hemiarthroplasty allows early mobilization and prevents revision surgery.     

Integrity of the lateral femoral wall in intertrochanteric hip fractures: an important predictor of a reoperation

BACKGROUND: Reoperations after intertrochanteric fractures are often necessitated by fracture displacement following mobilization of the patient. The biomechanical complexity of the fracture, the position of the implant, and the patient's characteristics are known to influence postoperative outcome. We investigated the importance of an intact lateral femoral wall as a factor in postoperative fracture displacement after fixation with a sliding compression hip screw. METHODS: Two hundred and fourteen consecutive patients with an intertrochanteric fracture were treated with a 135 degrees sliding compression hip screw with a four-hole side-plate between 2002 and 2004. The fractures were classified on preoperative radiographs according to the AO/OTA classification system. The status of the greater and lesser trochanters, the integrity of the lateral femoral wall, and the position of the implant were assessed postoperatively. Reoperations due to technical failure were recorded for six months postoperatively. RESULTS: Only 3% (five) of 168 patients with an intact lateral femoral wall postoperatively underwent a reoperation within six months, whereas 22% (ten) of forty-six patients with a fractured lateral femoral wall were operated on again (p < 0.001). Multivariate logistic regression analyses combining demographic and biomechanical parameters showed a compromised lateral femoral wall to be a significant predictor of a reoperation (p = 0.010). Seventy-four percent (thirty-four) of the forty-six fractures of the lateral femoral wall occurred during the operative procedure itself. A fracture of the lateral femoral wall occurred in only 3% (three) of the 103 patients with an AO/OTA type-31-A1.1, A1.2, A1.3, or A2.1 intertrochanteric fracture compared with 31% (thirty-one) of the ninety-nine with an AO/OTA type 31-A2.2 or A2.3 fracture (p < 0.001). CONCLUSIONS: A postoperative fracture of the lateral femoral wall was found to be the main predictor for a reoperation after an intertrochanteric fracture. Consequently, we concluded that patients with preoperative or intraoperative fracture of the lateral femoral wall are not treated adequately with a sliding compression hip-screw device, and intertrochanteric fractures should therefore be classified according to the integrity of the lateral femoral wall, especially in randomized trials comparing fracture implants.     

Surgical treatment of intertrochanteric hip fractures with associated femoral neck fractures using a sliding hip screw

OBJECTIVE: The purpose of this study was to report the results of surgical treatment of a subset of intertrochanteric fractures with posteromedial comminution and extension of the fracture line into the femoral neck using a sliding hip screw. DESIGN: Retrospective review. SETTING: Level I county trauma center. PATIENTS: Twenty-nine fractures (8%) with this pattern were identified from 381 intertrochanteric hip fractures treated at a single institution over a 10-year period. Nine patients were excluded (2 died, 7 had incomplete radiographic follow-up), leaving 20 patients for assessment. INTERVENTION: All fractures were treated with a sliding hip screw. MAIN OUTCOME MEASUREMENTS: Radiographs at a mean follow-up of 17 months were recorded as demonstrating: 1) fixation failure; 2) fracture union; or 3) fracture nonunion. The tip-apex distance, amount of lag screw collapse, screw position in the femoral head, and adequacy of reduction were determined. RESULTS: Treatment failed according to these radiographic measures in 5 of 20 (25%) fractures. Failures included fracture nonunion (1 case), lag screw cutout (2 cases), and combined nonunion/lag screw cutout (2 cases). All 5 failures had complete collapse of the lag screw, whereas 4 of the 15 successfully treated fractures had complete collapse. The amount of collapse was significantly greater for the treatment failures (mean, 38 mm) than in the successfully treated hips (mean, 20 mm). There was no significant association between treatment success or failure and tip-apex distance, lag screw position, and adequacy of reduction. CONCLUSION: We conclude that intertrochanteric hip fractures with associated femoral neck fractures should not be managed with a standard sliding hip screw.     

Technical pitfalls in the use of the sliding hip screw for fixation of intertrochanteric hip fractures

Two hundred fifty consecutive intertrochanteric fractures treated with a sliding hip screw (SHS) over a three year period were reviewed and specific types of technical pitfalls identified. Most pitfalls were technique dependent and potentially preventable with proper attention to the principles of fracture reduction and insertion of the device. Pitfalls encountered with the use of the SHS occurred as a result of either poor fracture reduction or implant insertion. Problems related to fracture reduction included poor radiographic visualization, posterior sag, varus angulation, and internal rotation of the femoral shaft in relation to the femoral neck. Potential pitfalls encountered during SHS insertion included superior guide wire placement, guide wire breakage or penetration into the hip joint or pelvis, loss of reduction during lag screw insertion, improper screw-barrel relationship, and improper plate application. Finally, the SHS may not be the implant of choice for all extracapsular hip fractures (i.e., the reverse obliquity fracture). This paper identifies the various pitfalls that may occur with the use of the SHS for the fixation of intertrochanteric hip fractures. Illustrative cases are provided and guidelines for avoiding these surgical pitfalls suggested.     

Functional outcome of ipsilateral intertrochanteric and femoral shaft fractures

OBJECTIVES: The purpose of this study was to compare the functional outcome of patients with ipsilateral intertrochanteric and femoral shaft fractures treated with a reconstruction nail versus a sliding hip screw and retrograde nail. DESIGN: Retrospective cohort study. SETTING: Two level 1 trauma centers. PARTICIPANTS: Twenty-six patients with ipsilateral intertrochanteric and femoral shaft fractures treated between 1993 and 2003 with a reconstruction nail (n=13) or with a sliding hip screw and retrograde nail (n=13). INTERVENTION: Internal fixation with a reconstruction nail or a sliding hip screw and retrograde nail. MAIN OUTCOME MEASUREMENTS: Functional outcome was measured using the Short Form-36 (SF-36), Short Musculoskeletal Functional Assessment (SMFA), and Lower Extremity Functional Scale (LEFS). RESULTS: The average time to follow-up was 49.6 months. Functional outcome was significantly better in the sliding hip screw with retrograde nail group for the role emotional (P=0.001) and mental component scores (P=0.016) of the SF-36. This group also scored better on the LEFS, although not reaching statistical significance (P=0.099). CONCLUSIONS: For most outcome measures, no significant differences in functional outcome scores were observed between the 2 treatment groups. The results of this study suggest the need for a randomized controlled trial with a larger sample size to more definitively compare the 2 fixation constructs.     

透视图像导航下微创动力髋螺钉治疗老年股骨转子间骨折

目的探讨在X线透视导航下微创置入动力髋螺钉(DHS)治疗老年股骨转子间骨折的临床应用。方法自2005年12月～2006年6月,笔者应用导航下微创方法置入DHS治疗老年股骨转子间骨折18例,男5例,女13例;年龄60～92岁,平均76岁。结果术后随访5～12个月,平均9个月。18例股骨转子间骨折的应用结果令人满意。手术时间平均为105min。X线图像采集平均5次。术中和术后无并发症发生。结论使用导航系统微创置入DHS不仅进针方向精确、拉力螺钉位置好、切口小,而且还可以减少术者的X线暴露时间,是治疗老年股骨转子间骨折的理想方法。     

应用股骨近端髓内钉与动力髋(髁)螺钉治疗老年股骨转子间骨折的对比分析

[目的]比较应用股骨近端髓内钉(PFNA)与动力髋(髁)螺钉(DHS/DCS)治疗老年股骨转子间骨折的临床效果。[方法]应用股骨近端髓内钉(PFNA)治疗老年股骨转子间骨折患者49例,应用动力髋(髁)螺钉(DHS/DCS)患者62例,分别对术中出血量、手术时间、术中和术后并发症、术后髋关节功能评分进行比较分析。[结果]DHS组手术方式出血量显著高于PFNA组(P<0.05),术后并发症显著少于DHS/DCS组(P<0.05),髋关节功能(Harris评分)优良率显著高于DHS/DCS组(P<0.05)。[结论]多数情况下,股骨近端髓内钉(PFNA)在治疗老年股骨转子间骨折时较动力髋(髁)螺钉(DHS/DCS)具有显著优势。     

股骨干骨折合并同侧股骨颈骨折治疗的临床观察

目的：探讨股骨干合并同侧股骨颈骨折的治疗特点和不同固定方法的疗效。方法：股骨干骨折合并同侧股骨颈骨折27例,男22例,女5例;年龄14～65岁,平均35岁。动力髋螺钉（DHS）固定3例,加压钢板加空心加压螺钉固定12例,重建钉固定8例,顺行髓内钉加空心加压螺钉固定4例。13例固定术前用克氏针临时固定股骨颈骨折。结果：术后随访36～75个月,平均44个月。25例股骨颈骨折平均愈合时间4.5个月,2例股骨颈骨折不愈合。27例股骨干均愈合,平均愈合时间6个月。未用克氏针临时固定股骨颈骨折14例中,2例出现股骨颈不愈合,3例轻度髋内翻畸形。结论：股骨干合并同侧股骨颈骨折有许多固定方法可供选择,加压钢板加空心加压螺钉固定简便易用,在实施固定术前用克氏针临时固定股骨颈骨折可避免股骨颈骨折再移位和损伤。