Foreword

Fractures of the upper extremity of the femur have existed and have been the cause of numerous problems since the dawn of time. They often result in definitive pseudarthroses, in the case of many transcervical fractures, or in malunions, which are more or less tolerated in fractures of the trochanteric area.

Interestingly, none of the treatments developed at the beginning of the modern era - the use of prolonged traction or the spica cast technique, introduced by Whitman - changed the generally poor short-term prognoses associated with treatment of the elderly patient with a fracture of the hip. Both methods required extended bed rest, usually resulted in numerous complications and frequently led to the death of the patient.

It was the modern approach of osteosynthesis that radically changed the short-term and general prognoses of these fractures, due to its ambitious goals: early weight-bearing, and, if possible, full weight-bearing, afforded by stable fixation.

Regarding trochanteric fractures - which represent a major health problem in an aging population - surgical treatment was initially done by open procedures using devices such as the articulated blade plate, like that of Mac-Laughlin; the “monoblock”, angled blade plates of 130° or 95°; and, more recently, the compression screw/plates, e. g. the AO/ASIF Dynamic Hip Screw (DHS). However, open procedures increased the risk of bleeding and infection; and, with a longer lever arm and decreased mechanical performances, they did not allow early weight-bearing in complex fractures.

Techniques inspired by the principles of Küntscher and which employ closed procedures have been developed and perfected. They are less aggressive to the periosteal envelope and display better mechanical characteristics, due to a shortened lever arm. The Küntscher Y-nail was a pioneering development in this field, followed by the Ender flexible nails and, lastly, by the Gamma nail. The latter currently represents a real challenge to the concept of Dynamic Hip Screw (DHS) fixation.

This special issue of the journal Osteosynthesis and Trauma Care is dedicated to the update of this method of osteosynthesis.