Pugh Nail Fixation of Displaced Femoral Neck Fractures

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Abstract
Of 695 intracapsular hip fractures with known end results, 80 per cent occurred in women whose average age was 71 years; of 101 consecutive undisplaced intracapsular fractures reported up to 1959, 81 were treated by internal fixation and 20 nonoperatively and all united but 11 per cent developed necrosis. From 1937 to 1959, displaced intracapsular fractures at St. Luke's Hospital were generally treated by closed reduction and Smith-Petersen nail fixation. From 1948 to 1952, 22 per cent of these fractures failed to unite, but from 1952 to 1959, 44 per cent failed to unite. Many of the failures were due to the Smith-Petersen nail backing out. These poor results inspired another device which might provide better fixation and prompted the use of the telescoping Pugh nail. From 1955 to 1971, the telescoping Pugh nail was used in 256 displaced intracapsular fractures with known end results. Ninety per cent united, and avascular necrosis was seen in 17 per cent of the united fractures. Since many of the patients with avascular necrosis has no pain, they were considered satisfactory results. Subtracting these 17 per cent of 256 patients with displaced intracapsular fractures of the femoral neck may be evaluated as examples of satisfactory results with the Pugh nail.

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