Percutaneous pinning of intracapsular hip fractures

Femoral neck fractures constitute one third of all hip fractures in the United States. The literature suggests union rates from 85% to 95% and late segmental collapse between 7% and 12% in fractures treated by internal fixation. We advocate percutaneous pinning in situ for all nondisplaced fractures of the femoral neck (Garden stages I and II). Displaced fractures of the femoral neck (Garden stages III and IV) are manually reduced, fluoroscopically evaluated as described, and percutaneously pinned. Postoperatively these patients are allowed immediate full weight bearing. Although hemiarthroplasty has been advocated, complications including dislocation, deep wound infection, loosening, protrusio, and component migration, far outweight the relatively minor problems facing the surgeon with a failed percutaneous pinning. Secondary femoral head replacements for failed percutaneous pinnings have a substantially lower incidence of complications than primary replacements for the treatment of acute femoral neck fractures.