All articular fractured should be surgically repaired. I could stop right here but I am feeling compelled to have a certain number of words on the page in order to make it Newsletter worthy. So here we go.
Incongruence is the number one reason for osteoarthritis (OA) to develop in a joint. So if a joint is fractured and not put back together in a near perfect manner then the joint will be incongruent. The amount and rapidity with which the OA will ensue will be proportional to degree of incongruence.
Hence surgical repair can help minimize the OA (not prevent from occurring as we already have trauma, and surgery is yet another trauma – see workshop on OA).
So, if you are dealing with a an articular fracture, strongly recommend/push for surgical repair as this will result i n the very best outcome for your patient.
Now if that is not an option and displacement is not huge, then I would try conservative management (splint, rest and pain medications) before considering an amputation.
Now if the fracture is in the coxofemoral joint (capital physeal, acetabular, femoral neck) then consider a Femoral Head Ostectomy.
