50 Years Ago in CORR: Function Fixation of Femoral Neck Fractures; Telescoping Nail Technic William K. Massie MD CORR 1958;12:230–255

Excerpt

This month’s symposium is devoted to the biomechanics of fracture healing. The importance of ensuring proper mechanical conditions for fracture repair has been known since antiquity: the ancients empirically knew motion impaired healing and a certain amount of immobilization was required for healing. Sir W. Arbuthnot Lane, one of the pioneers in internal fixation (and one of whose articles we republish in this issue [2]) recognized the importance of obtaining “absolute fixation of the fragments” to “yield better results than methods which fall short of this…” [1]. A half-century later, William Massie was another pioneer in the development of fracture fixation when he introduced a sliding hip nail [3]. Massie reviewed the history of internal fixation of hip neck fractures and emphasized the two major complications: nonunion and osteonecrosis. The former related in large part to the failure to achieve proper mechanical conditions and the latter to injury to the blood supply to the femoral head either from the injury or the treatment. Early attempts at internal fixation of femoral neck fractures reduced mortality (undoubtedly by allowing patients earlier function and avoiding prolonged bedrest or casting) but did not reduce the rates of nonunion. In contrast, Massie’s review illustrates the advances in operative treatment by mid-century almost always resulted in lower rates of nonunion but still did not necessarily reduce the rates of osteonecrosis. Proper treatment, he argued, depended upon obtaining, then maintaining proper alignment, apposition, and immobilization of the fragments. “Every uncomplicated fracture should heal if optimum conditions are provided,” he stated (italics his). Alignment was assured by proper reduction and he emphasized the importance of proper alignment in the frontal and lateral planes. Apposition was achieved by ensuring compression on the fracture surfaces as the inevitable resorption occurred. Immobilization required the proper mechanical conditions. The ability to achieve these latter two goals depended upon the design of an internal fixation device. …