This is Smith-Petersen's landmark 1937 report summarizing his evolving technique for internal fixation of femoral neck fractures. It traces the transition from his original open-reduction approach to closed reduction with lateral nailing under biplanar radiographic control. It addresses union rates, technical principles for nail insertion, and when open reduction remains necessary.
Every femoral neck fracture reduction requires both AP and lateral radiographs before you commit to fixation. Smith-Petersen and his discussants are unambiguous: the lateral view is not a formality. Rotational malalignment is invisible on the AP alone, and omitting the lateral is the single most common cause of nonunion in this series.
When you reduce a femoral neck fracture, aim for slight valgus. It is mechanically stable under load. Varus is not — it will fail under weight bearing regardless of implant quality.
For established nonunion (up to 24 months), open reduction with scar debridement and surface freshening is indicated in younger patients and achieves union in roughly 75% of cases. Do not offer this operation to elderly patients; Smith-Petersen is explicit that it is too demanding.
Radiographic union in femoral neck fractures is not reliable confirmation of healing. Smith-Petersen found true nonunion after removing nails from fractures that looked healed on X-ray, including at more than one year. Minimum 2 years of follow-up is required before calling a result an end-result.
This is Smith-Petersen's landmark 1937 report summarizing his evolving technique for internal fixation of femoral neck fractures. It traces the transition from his original open-reduction approach to closed reduction with lateral nailing under biplanar radiographic control. It addresses union rates, technical principles for nail insertion, and when open reduction remains necessary.
Every femoral neck fracture reduction requires both AP and lateral radiographs before you commit to fixation. Smith-Petersen and his discussants are unambiguous: the lateral view is not a formality. Rotational malalignment is invisible on the AP alone, and omitting the lateral is the single most common cause of nonunion in this series.
When you reduce a femoral neck fracture, aim for slight valgus. It is mechanically stable under load. Varus is not — it will fail under weight bearing regardless of implant quality.
For established nonunion (up to 24 months), open reduction with scar debridement and surface freshening is indicated in younger patients and achieves union in roughly 75% of cases. Do not offer this operation to elderly patients; Smith-Petersen is explicit that it is too demanding.
Radiographic union in femoral neck fractures is not reliable confirmation of healing. Smith-Petersen found true nonunion after removing nails from fractures that looked healed on X-ray, including at more than one year. Minimum 2 years of follow-up is required before calling a result an end-result.