In recapitulation, eighteen consecutive unimpacted intracapsular fractures of the hip have been treated with the corkscrew bolt. Of the fourteen earliest cases herewith considered, bony union has been obtained in ten. As yet, no necrobiotic changes in the femoral head have appeared. The clinical course of these patients has been noteworthy because of the absence of complications that are not infrequent with other fixative devices.
Analysis of the failures reveals a clear cause for each of them that in future cases can be minimized or completely eliminated. The risk of death due to wound infection, as occurred in one case, should be greatly diminished by the use of the simple technique of insertion, including lateral control, which has been presented. Death due to cystitis and ascending infection should not occur again, since the danger of hasty catheterization has once more been demonstrated, and we have been able to avoid it in all subsequent cases by the careful employment of conservative stimuli. Moreover, there would appear to be no excuse for a recurrence of the two failures that were due to the use of corkscrew bolts of improper metallic structure. The use of tool steel of low temper or vitallium appears entirely safe.
These experiences with the corkscrew bolt indicate its mechanical efficiency and justify its continued use. The causes of early difficulties have been identified and measures have been presented to diminish or to eliminate their recurrence.
(C) 1939 All Rights Reserved.The Journal of Bone and Joint Surgery, Inc.