Fifty-five of the fractures were recent; nine were in the neck of the femur, and seven were cured. The two failures were owing, in one instance, undoubtedly to improper reduction, and in the other to the removal of the cast in three weeks and the patient'S refusal of further treatment. Forty patients were observed to end results; thirty-five (87.5) had obtained entirely satisfactory results. Although I am not prepared to state, from such a small series of cases, whether open operation or conservative measures is the preferred treatment, I do not hesitate to operate on patients, providing conditions are satisfactory, if I am satisfied that the fragments are not in good position.
One hundred sixty-five of the fractures were old, or end results of fractures of the femur. It is difficult to judge the conditions under which the primary treatment was carried out, but it was undoubtedly quite inefficient in the greater number of cases. In the smaller number, union had been slow and the pull of the powerful muscles, or too early weight bearing had caused bowing. It is difficult to determine from the roentgenograms or from clinical examinations when union is complete in a case of malunion. On opening some of the fractures of this type, motion was easily demonstrated. In fifty patients, the causes of the disability were faulty end results following fractures of the neck of the femur. Five patients were not traced and six were not operated on by the open method; the remaining thirty-nine were operated on. Osteotomy for malunion was performed in two; the others were treated for non union, and twenty-eight (71.7 per cent.) were cured. In cases in which the neck was absorbed and union was attempted by using a bone peg, failures were uniform. A fair amount of neck must remain if there is to be any chance of union. The Brackett operation is the method of choice when the neck is destroyed.
One hundred fifteen patients with fractures of the shaft were treated and ninety-eight were traced. Sixty-nine were operated on and 76.7 per cent. were cured. Twenty-nine were treated by conservative measures, and twenty-seven (93.1 per cent.) obtained satisfactory results.
End Results in Fractures of the Femur, 222 Cases. 57 Recent Fractures; 165 Old Fractures. [See Table in PDF Source.]