Internal fixation of intracapsular hip fractures

The technique for internal fixation of intracapsular hip fractures is demanding. After a fracture of the femoral neck in both young and old patients, the best clinical results are obtained by anatomic reduction and multiple screw or pin fixation. The closed anatomic reduction can be obtained in the majority of cases. If this cannot be accomplished, open reduction is necessary. Three-point fixation is ideal for control of motion at the fracture site and secure fixation. This is best accomplished with a triangular pattern of pins or screws with the inferior screw resting on the medial cortex of the femur at an angle of 135°. The remaining screws are superior to the inferior screw in an anterior and posterior position parallel to the first screw. Using this technique, optimum results with minimal avascular necrosis and nonunion can be expected in intracapsular fractures.