Subcapital fractures of the femur in rheumatoid arthritis.

A review of 40 subcapital fractures of the femur in 37 patients with rheumatoid arthritis has shown that no displaced fracture treated by reduction and fixation united, even when it had been acceptably reduced and fixed. Primary prosthetic replacement of the femoral head gave significantly better results, at least in the short term. A postoperative deep infection rate for prosthetic replacement of one in five was reduced to zero by prophylactic antibiotics: current treatment with oral corticosteroids did not increase the risk of infection. The possibility of a stress fracture of the femoral neck should be considered if a patient with chronic rheumatoid arthritis presents with increasing hip pain after minimal trauma.