Compression Fixation of the Femoral Head by Transarticular Nailing

Arthrodesis of the hip joint should be adopted with a unique indication different from other surgical procedures, such as arthroplasty and osteotomy because of its excellency in the analgesic support of the joint, improvement in the form of gait and independency of muscular equilibrium, coupled with changes in the living style of the Japanese. Marked surgical stress, the necessity for a long-term complete rest and the difficulty in complete articular union are the shortcomings of this procedure. Through an attempt of arthrodesis of the hip joint for relatively young people according to the Davis modification, the authors fully realized that there was considerable surgical stress even though a long-term complete rest was unnecessary. The theory of compression arthrodesis originated by Key, Charnley et al, is supplemented by the idea by Roux, Hiss, Krompercher and Pauwels and Biebel that the blocking compression power of flexing force and shering force accelerates callus formation. Wustmann applied it clinically as “Kontakt Osteosynthese” and Kontak-tarthrodese. The AO group including M. Müller and Axer, Fox, Niebauer, McKee and others reported on arthrodesis of the hip joint as “Kompressionsarthrodese” respectively. On the other hand, there are too numerous surgical modifications for medial neck fracture of the femur to mention because of the difficulties of its treatment. Recently, Barnes, Kahl and Forgon reported on surgical methods in consideration of the application of compression power. Aiming at the improvement of these points, the authors have been attempting to introduce compression power to hip surgery over several years and have obtained some information through a few cases which is reported below. The following test was attempted to find the permissible compression power of the screw together with deformities of the pelvis and the head of the femur. Dried pelvis of cadaver and fresh head of the femur were compressed using compressing bars, 10mm and 15mm in diameter, in the Amsler type test machine and the grade of deformation was obtained respectively. At the three points of pelvic space side of the dried pelvis of the cadaver, compression power ranging from about 20 to 60kg/cm2 caused fissure. In the fresh pelvis, no fissure was induced by compression ranging from the minimum of 67.4kg/cm2 to the maximum of 78.6kg/cm2. As compression was applied to the femoral head, the cartilage and cortex in the compressed region were easily crushed and sank i