Preface To The German Edition

Femoral neck fractures are lesions most often observed in elderly people. They are of great importance to society and health care providers alike. In spite of a marked improvement of implants, surgical techniques and patient care, these fractures constitute a major burden to our national economies. The incidence of femoral neck fractures is expected to increase worldwide from 1.7 million in 1990 to 6.3 million by 2050. The number of hip fractures in Germany amounts each year to 90.000. Given the ever-increasing age of our population this number is expected to double by 2050.

The improvement over time in the treatment of femoral neck fractures parallels the development of trauma surgery. Consecutive milestones were the treatment by traction, the realization of the importance of early anatomic reduction and above all an effective maintenance of reduction. Contributing to these improvements were design of important fracture implants and development of various types of joint replacement.

In spite of these marked technical progresses the femoral neck fracture remains a problem giving rise to many controversies. The search for solutions extents from epidemiology, osteoporosis research and prevention to the improvement of existing implants and design of new ones. While focusing on solutions one should always keep in mind their impact on the limited resources of our health care systems.

Professor Manninger and his team of hip surgeons merit special praise for their treatment approach to this problematic fracture. Continuous and meticulous clinical and basic research extending over five decades, often performed under difficult political and economic conditions, forms the basis of this book.

The main goal of these research endeavors was not only the search for a stable internal fixation, par ticularly in older patients having a reduced bone strength, but also to device an operating technique interfering the least possible with blood supply and the patient's general condition. As a prerequisite this team investigated the bony structure of the proximal femur in older subjects, the blood supply to the femoral head, the various fracture patterns as well as biomechanical aspects. Manninger and his team using numerous intraosseous venographies were able to show most elegantly the correlation between disturbed blood drainage from displaced neck fractures and posttraumatic avascular necrosis. They were also able to prove that an early anatomic reduction restores the venous drainage and thus reduces dramatically the risk of avascular necrosis. A meticulous analysis of the postoperative course of several thousand femoral neck fractures allowed to improve steadily the surgical technique and the implants, be it an improved or new design. The results led to the development of a family of implants assuring a stable internal fixation of a wide spectrum of fractures including undisplaced fractures, comminuted breaks and fractures at the trochanteric level.

Thanks to the vision and energy of pioneers such as Prof. Manninger we have nowadays at our disposal a cost efficient joint preserving alternative to arthroplasty. The present monograph reflects the wealth of experience that Manninger during the many years as chief of the National Institute of Traumatology as well as his predecessors in Budapest gained and transmitted to their pupils. Mannin-ger's "Internal Fixation of Femoral Neck Fractures" is a most important work of high scientific value. At a time when the indication for a joint replacement is often established too fast and the technique of internal fixation decreasingly well mastered, trauma surgeons must be thankful to the authors for having written this book.

Hanover, May 2004

Prof. Dr. Harald Tscherne (former director of the Department of Trauma Surgery, Hanover Medical School, Hanover, Germany)

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