Almost always decompress capsul

Never

Never in a closed reduction

For an intra-capsular fracture undergoing closed reduction and internal fixation, one of the aetiologies for the later development of AVN was thought to be the pressure effect of the haemarthrosis which would be dissipated by a capsular decompression. The development of AVN is however likely to be multi-factorial. Whilst in a paediatric patient there are some strong advocates for a decompression, the evidence remains mixed. As a patient gets older it would seem this pressure effect is reduced but again there are only small studies with no clear-cut evidence. Therefore no consensus for its universal use.

It has some anecdotal evidence in kids. Not in routine practice

I do not remembrar having any due to a fracure in my practice

Thank you all for valuable inputs.

I prefer firstly to do ultrasound evaluation of the joint efusion or haemarthros, by anterior approach with linear transducer 5 - 7.5 MHz.

By anterior approach we can assess Anterior Capsular Distance (distance between the femoral neck and anterior joint capsule) . If the distance is

higher than 5 mm I prefer decompression.

Never in closed reduction

In young adults it's secondary to high energy trauma. Therefore I believe there's already a suspicion of capsular tear. So I don't think there's a need for decompression.

In elderly population it's a fragility fracture rarely we go for osteosynthesis. So again need for decompression doesn't arise.

Coming to kids there's anecdotal evidence for Decompression/ aspiration. Therefore routinely not done in my practice.

Capsulotomy is must when treating fracture neck femur by hemireplcement in elderly persons. In younger and middle age persons aspiration of hip is supposed to help in preventing AVN/ nonunion by joint decompression. As a routine I don't do capsulotomy while treating fracture by internal fixation after its closed reduction. Of course in open reduction cases it occurs as part of the procedure.

I never do capsulotomy/ aspirate hip before closed reduction and fixation of fracture neck femur in young.

In cases where,we operate within 24 hours ,we aspirate on table to reduce the intra artcular pressure