Preston A. Wade

The problem of the supracondylar fracture of the femur in the aged person

Abstract The supracondylar fracture in the aged person is usually sustained in the female patient with markedly decalcified femur, and is usually the result of a minor fall. These fractures result from an unnatural leverage applied at the supracondylar area due to a predisposing knee or joint disability, or in many instances, disability of both joints. These fractures present a very difficult problem in treatment since the patients do not stand long periods of immobilization well and operative methods are beset with complications.

Management of intertrochanteric fractures of the femur

Abstract A review has been made of 183 intertrochanteric fractures which have been treated in an eight and a half year period on the Combined Fracture Service of the New York Hospital and the Hospital for Special Surgery at the Cornell University Medical School, in an effort to evaluate the various methods of treatment in use since 1950. All but thirteen patients received internal fixation. Categories have been presented in regard to the reasons for non-operative management; sex, race and age of the surgical patients and the side injured; the amount of displacement of the fractures; the type of internal fixation devices employed; antibiotics and the incidence of infection; complications related and unrelated to the type of internal fixation used, the former including the occurrence of varus and penetration of the hip joint; and follow-up evaluations and a listing of the deaths. Discussion has been directed at explanation of the reasons for failures and for the shift in preference generally from the Lorenzo screwplate combination apparatus to the solid Jewett nail-plate. An effort has been made to outline the technical hazards which have arisen in use of the latter device.

The use of intramedullary prosthetic replacement in fractures of the femoral neck

Abstract In both primary and secondary replacement arthroplasty for subcapital fractures of the femur, the mortality rate which we observed has been almost three times less than any reported in the literature for a similar large group of subcapital fractures which were treated by reduction and internal fixation. We realize that this mortality rate may be lower than will occur in the future, because many of these patients received prosthetic arthroplasty primarily in deference to their poor general condition and probable inability to benefit from reduction and internal fixation of subcapital fractures. Including postoperative complications, our end results have been twice as good with the Judet prosthesis and six times as good with the Moore-Thompson type replacement as those reported in several large studies of subcapital fractures treated by reduction and internal fixation in which the incidence of non-union and necrosis, early or late, has been about 50 per cent. Therefore, we are encouraged to expand the use of primary replacement of the femoral head in the more severe types of subcapital fractures, and to lower the age candidacy to include patients in the sixth decade of life. With the exception of late secondary replacement where abundant viable neck exists, we would not recommend the use of the Judet prosthesis. If the Judet type reconstruction is attempted, the Vitallium prosthesis should be used and only by those who are most experienced and skilled in the intricate and exact technicalities of its application. Although we are encouraged by our findings (Fig. 6), we recognize the need for intensive investigation of all types of subcapital fractures in an effort to find improved methods for saving the femoral head and obtaining union by reduction and internal fixation. It is our hope that further investigation will define the indications for primary replacement of the femoral head in those cases which would be doomed to failure by efforts at reduction and fixation. Certainly no such criteria is presently available in the literature.

Fractures in children

Management of fractures in children is completely different from those in adults. The biological reaction to fracture is characteristic in children because of the anatomic, physiological, and biomechanical properties of skeletal structure. Comprehension of the property of bone in children is essential to treat fractures. Some properties act favorably for bone union and some make it difficult to treat the fractures.