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Loss of reduction within 4 months

4 (2.7%)

20 (4.9%)

p = 0.263

Total number of loss of reduction

5 (3.4%)

28 (6.9%)

p = 0.127

The level of walking ability was significantly better in patients with cannulated screw fixation than those who underwent nailing. The majority of patients with cannulated screw fixation were able to ambulate either without a walking aid or with only one cane; in the same group the incidence of patients confined to bed was lower, they also complained less about strong hip pain. On the other hand, the number of patients who were free from pain was greater after nailing. It can be assumed that some patients treated with screw fixation and examined after longer intervals and had been of poor general health at the time of injury were still living.

The incidence of complications (Table 10) as it relates to the invasiveness of the type of surgery (hematoma, infection) was slightly reduced. We believe that this is partly due to the better drainage from the femoral head along the cannulated screw than along the nails. It is worthwhile to note that at this time the use of suction drains in the small wound was not used routinely. Also soft tissue sleeves were not in common use. Both factors may explain the observation that the number of complications after percutaneous cannulated screw fixation, mostly due to tissue damage, did not decrease appreciably (see Sect. 11.4.1).

Screw migration developed mostly in instances where no 2 mm plates were used. The marked increase in loss of reduction, particularly for Garden-III and -IV fractures, seems to be due to the different biomechanical characteristics of both implant types. These results led to further investigations with the goal to increase the stability of internal screw fixation.

Assessment

Once the technique had been mastered, the cannulated screw fixation met in part our expectations shortly after the start of the investigation. Duration of surgery and hospital stay were reduced. The mortality rate and the late function were more favorable to a certain extent. On the other hand, the number of complications reflecting the invasive-ness of the procedure did not decrease. The analysis of the causes of hematomas and infections pointed to the importance of soft tissue protection and wound drainage.

Further investigations and tests with the goal to increase stability became necessary to reduce the incidence of the increasing number of loss of reduction.

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