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There are a lot factors in the genesis of the ischemic femoral head necrosis. In the early stage the intraosseous pressure increases without any clinical or radiological sign. The disease is often bilateral. The early diagnosis (NMR) is essential in the treatment. In the case of a severe femoral head necrosis the radiological investigation of the other side is obligatory, in order to diagnose the early stage of the disease and to prevent the progression of the collapse with core decompression. The object of the adequate treatment of the collapsed femoral head is to release the pain and to avoid the total destruction of the femoral head. The untreated femoral head necrosis results in a painful, arthritic hip, where spontaneous regeneration is limited, and takes 8-10 years. With osteotomy and revascularisation the results are good, and the regeneration takes about 2-3 years. As a result of this treatment, the patients have a moderately limited function, and minimal limping. Rehabilitation is possible into the original profession, or into a somewhat easier job. Remodellation of the femoral head in younger patients following the revascularisation procedure has been observed in our experience in the last few years.

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The authors report on follow-up of 754 patients (among them 713 patients aged over 50 years) with hip fracture, treated in the National Institute of Traumatology, in 1990. Excess mortality in a year amounted 23% of cases. One third (254) of the injured survived after 5 years, current health condition of 199 out of them has been evaluated in a questionnaire type survey. Analysis of results according to age, sex and fracture type was made. Definite correlation has been observed with the age, the increase being parallel to it, while age-specific mortality is higher in men. Again, mortality was higher in trochanteric fractures. On analyzing the patients' condition from the aspect of using walking aids, walking ability and complaints, particularly the high rate of painfulness differed from the literature data, though inadequate rehabilitation, already stated before, is reflected in other indicators, too. In addition to the improvement of early rehabilitation, based on their own results the authors emphasize, that further care of patients with complaints is also of great importance.

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We present a series of 247 undisplaced femoral neck fractures, of which 122 were primarily treated non-operatively, and 125 with primary operative stabilization. The background parameters did not differ significantly in the two groups. The length of hospitalization was 1 week shorter in the operatively treated group. They started to walk bearing full weight at an average of 11 days earlier. Two-thirds of the operatively treated but only one-quarter of the non-operatively treated patients were able to walk alone when they left hospital. General complications were recorded in 19 of the non-operatively and in four of the operatively treated patients during their hospitalization. Early displacement (within 6 weeks) was noted in 20 per cent of the non-operatively treated patients who required late operation. However, there was no early displacement in the operatively treated group. We therefore recommend primary operative stabilization of undisplaced femoral neck fractures.

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A case of a femoral head necrosis, with collapsed joint surface after fracture of the femoral neck will be presented. Following varisation osteotomy, the necrotic parts of the bone was removed and filled with cancellous bone. A standardized bone block of the iliac crest was implanted into the hole. After the operation the patient was painfree. The X-rays showed the improvement of the bony structure and later a spherical remodeling of the femoral head. This result is in opposition with the earlier opinion of the disability of femoral head remodeling in adults. It is technically very important to pack tight the hole in the femoral head with cancellous bone chips after necrectomy, and to ensure the revascularisation with vascularised bone block.

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The review of the occurrence, etiopathology, classification and diagnosis of the aseptic necrosis of the femoral head is followed by the description of the method of transplantation of the vascular pedicled bone graft. During 5 years implantation of 12 vascular pedicled bone grafts in 10 young patients with severe and of major extension necrosis of the femoral head was carried out. The early result was in every case the quick and significant decrease of pains and that the necrosis did not progress. In the early stage the severe consequence of the necrosis the collapse can be prevented with core decompression. In a later stage the vascular pedicled revascularization of the femoral head may retain in young patients, beside adequate hip movements, the gait and the working capacity. This, though it is not a final solution, will give chance by gaining time to perform prosthesis operations later.

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Authors have followed 754 patients with hip fracture and have found that about 60 per cent of them are alive after one year; their functional state further improved between 4 months and 1 year, it cannot be however considered as satisfactory even after one year. Analysing the operations performed in femoral neck and trochanteric fractures it should be stated that the operative indications are generally adequate and the conditions of further improvement are defined. More significant improvement of the lasting results can be expected from a well organized rehabilitation.

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Authors examined the results of the 4 months rehabilitation of 753 cases of hip fractures treated in one year in their Institute. It was stated that a significant part of the patients had to be discharged too early. It is contributed to the inadequacy of the rehabilitation possibilities of the patients that 3/4 of those living after 4 months have complaints, only half of them can leave their flat, only 1/5 walks without a stick and 1/3 with one stick. On the basis of Swedish experiences they see the possibility of improving their results in a closer cooperation with the primary health care.

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Authors report on a new osteosynthesis based on the double nailing of femoral neck fracture and screwing, and developed from the "Uppsala" double screwing. The preliminaries of the double cannulated screwing method, its advantages, the experiences gained in 30 cases operated in one year and the early results are described.

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Authors followed for 4 months the life of 753 patients with femoral fractures of the hip and state, that with an extension of the operative indication the hospital mortality was decreased to the half during 15 years in spite of the further rise of the age. It is contributed first of all to the inadequacy of the rehabilitation that the later mortality is high and it is the double of that in the hospital: not more than 3 of 4 injured reaches the 4 months control.

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As the literary data are contradictory, authors examined in 489 operated femoral neck fractures the significance of Garden's classification. Based on their material it was found that this classification gives help in the judgement of the single fractures and in the choice of the adequate treatment. For a more exact assessment however they think the consideration of the lateral Roentgenograms also necessary.

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Authors give a literary review of the pathomorphology and distribution of the Monteggia injuries. The necessity of the correct reduction of the ulna and the role of the interosseous membrane, the strength of which is able alone to eliminate the luxation of the radial head and to keep it on its proper place, are underlined and stressed. With the demonstration of a 9 week old injury it is proven: it is possible to restore the severely damaged elbow function with an adequate operative treatment.

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A review is presented of the classic vascularized iliac crest transfer and to show useful variations on this technique. A technical variation to reconstruct mandibular defects, the semisegmented iliac crest graft, is described. Another variation, the half iliac crest graft, is presented for use in the neovascularization of avascular necrosis of the femoral head. When such a flap is raised with a large periosteal flap and overlying muscle or skin, or both, as a composite flap, a primary osteoperiosteal tube can be created to reconstruct segmental defects in long bones. This primary osteoperiosteal tube is secondarily transformed into a completely osseous tube.

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The treatment of undisplaced femoral neck fractures, having been disputed for the past 50 years, is analysed on the basis of 111 observations during the period of 1981 to 1983. Osteosynthesis proved to be advantageous. Fixation with a three-flanged nail did not increase mortality rate, had no negative effect on late complications, while it could prevent dislocation and permitted full loading at an early stage.

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The authors report on the results obtained with surgical treatment of 470 femoral neck fractures, which they analyzed with reference to the type of break. The found that a fracture line with a zig-zag course signified the best prognosis for both healing and stability, whereas fractures with a posterior fragment had a poorer prognosis. The results support the urgency of the operation and confirm the higher proportion of cases treated for jagged fractures among those with good results.

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The value of internal fixation of fractures of the neck of the femur within 6 h was assessed in a review of a 3-year series. Three groups were compared, in which the operation was performed within 6 h, between 6 and 24 h and after 24 h respectively. The time and quality of union and the incidence of collapse of the head of the femur were significantly better in the first group. The difference in the results between the other two groups was not significant. In view of these data the authors recommend the internal fixation of fractures of the neck of the femur within 6 h.

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Implants have been used since 1969 by the authors for the replacement of damaged finger joints following trauma. In several cases reconstruction of other damaged tissues in the same finger was also performed. A method is described for replacement of the central slip of the extensor tendon over the PIP joint. Analysis of twenty-one MP and sixty-eight PIP endoprostheses placed in eighty-three patients until 1979 is given. Significant improvement in the range of movement is seen. Preoperative pain was relieved in all cases. There was a need to change occupation in ten percent of patients. Careful analysis of early and late complications calls attention to the proper selection of patients for surgery.

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Based on their 494 own cases with femoral neck fractures authors investigate the impact on time elapse between the injury and the osteosynthesis upon the outcome of these patients. By comparing two groups with equal severity it was concluded that an operation within 6 hours after the injury is favourable both with regard to the mortality and the systemic or local complications. They provide an explanation for the good results through the analysis of their cases and give a brief review of the literature on this subject as well.

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