A review is presented of the end-results in the treatment of 224 patients with fracture of the neck of the femur, at the University of Iowa Hospital. Of the 224 patients, 115 were aged 80 or older. The incidence of fracture non-union was no higher among the older patients.One fourth of the patients died in the first year after fracture; of those surviving, one fourth never walked again.There was a high correlation of adequate reduction and fixation of the fracture with final healing and a return to the prefracture ambulatory state.Increased life expectancy has compounded the "unsolved" problem of femoral neck fractures. The introduction of the three-flanged nail by Smith-Petersen in 1931 (1) changed the entire concept of the management of patients with these fractures. However, studies of end-results indicate an increased incidence of femoral neck fractures with little improvement in the rehabilitation or survival rates (2). The mortality dropped with the introduction of internal fixation as a method of management, and again with the introduction of antibiotic therapy, but since then there has been a plateau. The incidence of non-union of bone, aseptic necrosis and degenerative arthritis, although correlated well with the type of fracture and adqeuacy of reduction-fixation, is high even after ideal management (3). Goldstein and associates have previously reported the results of a detailed study of the experience with this fracture at the University of Iowa Hospitals between 1940 and 1952 (3). In an attempt to compare our current results with this earlier study we gathered the information which is the basis for this progress report.
CLINICAL MATERIAL AND METHODSThis review covers 224 patients with fractures of the neck of the femur admitted to the University of Iowa Hospitals during the years 1960 and 1961. These patients were treated almost entirely by the resident staff. Numerous surgeons were involved in the treatment, and this resulted in obvious variations in operative technic and postoperative care. The patients with displaced fractures of the femoral neck ordinarily were treated by reduction and internal fixation in the operating room as soon as surgery was practical and safe. This was usually within twenty-four hours after admission unless the patient presented with a problem necessitating further preoperative preparation, e.g., correction