[Radiographical and pathohistological study of the femoral neck fractures]

Femoral neck fractures are of great interest for challenging several problems to indicate surgical procedures. Even though ages and general or local conditions of the patient, and types of fracture or some other influencing factors are sufficiently taken into consideration, it is very difficult to foresee the fate of femoral head on the radiogram at the time of injury. This viability of fractured femoral head is the most important factor to choose the method of treatment, but no adequate method of assessing the viability has been established. One hundred and twelve femoral heads removed in the course of endo-prosthetic replacement were examined radiologically and histopathologically to study the factors influencing to the fate of fractured femoral heads. Histological findings of the femoral heads, in particular the extent of necrotic or revascuralized areas on the decalcified section stained with H-E, were compared with radiological findings such as the size or shape of the femoral head, the fracture line, the extent of displacement and osteoporosis or Singh's grade. Several factors which may influence the viability of the fractured femoral head have become clear. The site and direction of fracture line, extent of displacement and destruction of femoral head were thought to be important factors. Medial type of femoral neck fractures could be classified into four groups from a result of this study. They are less displaced, transcervical, crescent shape and severe displaced type. The first two may have a tendency to good revascuralization, and the last two groups to necrosis of the fractured head. This clinical classification is thought to be useful in the treatment of this fracture.