“We come into the world under the brim of the pelvis and go out through the neck of the femur”- William Felding (1964). This phrase speaks volumes regarding the bleak outlook and grave prognosis of fractures of the femoral neck till the early years of the twentieth century it was in a nutshell "the death blow to an old individual" It was little wonder, therefore, that the Smith Petersen nail was received sixty-five years ago as the panacea for femoral neck fractures as a welcome departure from Whitman's closed method of treatment. The treatment of these fractures is so fraught with failures that it has been have labelled as the unsolved fracture. The complex biomechanics acting at the upper end of the femur, the enrolling of synovium into the fracture site, synovial fluid washing away of the fracture haematoma and scanty blood supply to the femoral head all contribute to the high failure rates and unpredictable results. The rationale of treatment of closed fracture neck femur with fibular graft is based upon -: Decompression of the femoral head, interrupting the cycle of ischemia and interosseous hypertension, Removal of necrotic bone, grafting of the defect with fresh cortico-cancellous bone, Placement of a viable cortical bones strut to support the subchondral surface to prevent collapse and enhance the revascularization process by providing a source of mesenchymal stem cells.

Keywords- Abd, Add, AVN, AP, CORR, FWB, inf, JBJS, NWB, PWB, SLR, Tend.

1. W.D., Lyden. J.P., Minkoff, L.: Treatment of intracapsular fracture of the femoral neck J.B.J.S. 56A, 254, 1974.
2. Ayer A.:Treatment of intracapsular fracture with new compassion device JBJS. 45B, 806. 1963.
3. Baksi D.P. Choudhary A.K., Chatterjee N.D.: Different osteotomies and internal fixation with muscle pedicle bone grafting in the treatment of ununited femoral neck fractures. IJO 55-60, 1992.
4. Baksi D.P.: Treatment of osteonecrosis of the femoral head by drilling and muscle pedicle bone grafting. J.B.J.S. Br. 73, 241-245, 1991.
5. Boyd H.B. & Salvatore J.E.: Acute fracture of the femoral neck. Internal fixation or prosthesis J.B.J.S., 46A, 1066, 1964.
6. Campbell W.C.: The autogenous bone graft JBJ.S. 21, 3 July 1939.
7. Carrel W.B.: Transplantation of fibula in the same leg. B.J.S,3, 627, 1938.
8. Chacha P.B, Ahmed M., Daruwala J.S.: Vascular graft of the ipsilateral fibula for non-union of tibia. J.B.J.S, 638, 246-253, 1981.
9. Charnley Sir John: The treatment of displaced fracture of neck of the femur by compression J.B.J.S. 39B, 1, 45, 1957.
10. Chung S. M.K.: The arterial supply of the developing proximal and of the human femur. J.B.J.S., 58A, 951, 1956.
11. Clark D.I., Crofts C.E. & Saleh M.: Femoral neck fracture fixation J.B.J.S., 72B, 5, 1990.
12. Clarke 1.C. & Amstutz H.C.: Human hip joint geometry and hemiarthroplastic selection in the hip in proceedings of the third scientific meeting of the hip society 1975 St. Luis: 63.
13. Cleveland M. & Fielding J.W.: intracapsular fracture of the neck of the femur Vol. 12. Ann Arbor, J.W. Edwards, 1955.
14. Compere E.L. & Lee J.: Restoration of physiological and anatomical function in ununited intracapsular fraction of the neck femur J.B.J.S., 22, 261-277, 1940.
15. Deyerle W.M.: Absolute fixation of fracture of the hip with contact compression. Anew fixation device. Clinical ortho. 13, 279, 1959.
16. Deyerle W.M.: Multiple pin peripheral fixation in fraction of neck of femur- immediate weight bearing. Clinical ortho. 39, 1965.
17. Dickson J.A.: Treatment of ununited fracture of neck of the femur by means of bone graft and Smith Petersen nail, S.CNA. 19. 1235, 1939.
18. Fairbank A.C. Bhatia D., Jinnah R.H., Hungerford D.S.: Long term results of core decompression for ischemic necrosis of the femoral head, J.B.J.S. Br. 77, 42-49, 1995.
19. Henderson M.S. & Henderson E.D.: Bone grafts for ununited fractures of neck of the femur - a report of 90 cases J. Internal Coll Surge 9, 26-34, 1946.
20. Kane S.M., Ward W.A., Joedan L.C., Guilford W.B. & Hanley E.N. Jr: Vascularized fibular grafting compared with core decompression in the treatment of femoral head osteonecrosis: Ortho 19, 869-872, 1996.

Dr Rahmat Ali (Ms (Ortho), MCh (Ortho) )

Professor and H.O.D (Ortho Department), Maharishi Vashishtha Autonomous State Medical College,

Basti, UP, India