Treatment of unstable, intracapsular fractures of the femoral neck by the cementless self-locking cephalic endoprosthesis.

Between July 1981 and July 1986, 152 patients with an unstable, intracapsular fracture of the femoral neck were treated with a prosthetic replacement. In a selected group of 75 very old individuals, with an average age of 82 years, a self-locking cephalic endoprosthesis was chosen. These patients were closely followed prospectively, during 3 months. The operative technique, the pre- and postoperative management are discussed. There was no peroperative mortality. The postoperative mortality rate (30 days) was very low (5.3%). Accidental fracture of the proximal femoral shaft occurred twice, during insertion of the prosthesis. No postoperative luxation was seen. The walking capacity of the survivors, 3 months after surgery, was compared with the status before injury. The self-locking cephalic endoprosthesis is a safe and time-economizing operative procedure. In our opinion, it is the treatment of choice for unstable, medial neck fractures of the femur in elderly patients, with a poor general condition and a limited life expectancy.