Liporace, J Bone Joint Surg Am 2008 - Results of Internal Fixation of Pauwels Type-3 Vertical Femoral Neck Fractures

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Results of Internal Fixation of Pauwels Type-3 Vertical Femoral Neck Fractures

Liporace, Haidukewych, et al.·J Bone Joint Surg Am·2008·362 citations·Retrospective cohort

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Background

It has been postulated that femoral neck fractures with a more vertical fracture line (i.e., a high Pauwels angle) may experience more shear forces and therefore may be predisposed to nonunion or loss of fixation. Although there is controversy regarding which fixation method is ideal, we are aware of no large clinical series in which the treatment outcomes of these fractures were evaluated. The purpose of this multicenter study was to evaluate a large consecutive series of high shear angle (>70 degrees) femoral neck fractures to learn more about the outcomes, complications, and performance of various internal fixation strategies.

Methods

Between January 1993 and January 2005, 76 Pauwels type-3 (Orthopaedic Trauma Association [OTA] type-31B2.3) femoral neck fractures were treated in 75 patients with a mean age of 42 years.
14 patients were lost to follow-up.
62 fractures in 61 patients were followed to union or revision surgery, with a mean duration of follow-up of 24 months.
37 fractures were treated with cannulated screws and 25, with a fixed-angle device.
The reduction quality, accuracy of implant placement, time to surgery, influence of capsular decompression, and rates of nonunion and osteonecrosis were evaluated.

Results

59 (95%) of the fractures had good-to-excellent reduction, and 3 had a fair reduction.
There was a nonunion of 8 (14%) of the 59 fractures with a good-to-excellent reduction and 2 of the 3 with a fair reduction.
There was a septic nonunion of one fracture treated with a dynamic hip screw.
There was an aseptic nonunion of 7 (19%) of the 37 fractures treated with screw fixation alone as compared with 2 (8%) of the 25 fractures treated with a fixed-angle device.
Osteonecrosis occurred after treatment of 7 (11%) of the 62 fractures.

Conclusions

Despite timely, excellent reduction and accurate implant placement in the vast majority of cases, the nonunion rate was 19% for fractures treated with cannulated screws alone and 8% for those treated with a fixed-angle device. Although these failure rates are not significantly different, we believe that this study documents the challenging nature of this fracture pattern and the ideal fixation device remains undefined.

Copyright remains with the authors and publisher.

Results of Internal Fixation of Pauwels Type-3 Vertical Femoral Neck Fractures.

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Results of Internal Fixation of Pauwels Type-3 Vertical Femoral Neck Fractures

Liporace, Haidukewych, et al.·J Bone Joint Surg Am·2008·362 citations·Retrospective cohort

|

Background

It has been postulated that femoral neck fractures with a more vertical fracture line (i.e., a high Pauwels angle) may experience more shear forces and therefore may be predisposed to nonunion or loss of fixation. Although there is controversy regarding which fixation method is ideal, we are aware of no large clinical series in which the treatment outcomes of these fractures were evaluated. The purpose of this multicenter study was to evaluate a large consecutive series of high shear angle (>70 degrees) femoral neck fractures to learn more about the outcomes, complications, and performance of various internal fixation strategies.

Methods

Between January 1993 and January 2005, 76 Pauwels type-3 (Orthopaedic Trauma Association [OTA] type-31B2.3) femoral neck fractures were treated in 75 patients with a mean age of 42 years.
14 patients were lost to follow-up.
62 fractures in 61 patients were followed to union or revision surgery, with a mean duration of follow-up of 24 months.
37 fractures were treated with cannulated screws and 25, with a fixed-angle device.
The reduction quality, accuracy of implant placement, time to surgery, influence of capsular decompression, and rates of nonunion and osteonecrosis were evaluated.

Results

59 (95%) of the fractures had good-to-excellent reduction, and 3 had a fair reduction.
There was a nonunion of 8 (14%) of the 59 fractures with a good-to-excellent reduction and 2 of the 3 with a fair reduction.
There was a septic nonunion of one fracture treated with a dynamic hip screw.
There was an aseptic nonunion of 7 (19%) of the 37 fractures treated with screw fixation alone as compared with 2 (8%) of the 25 fractures treated with a fixed-angle device.
Osteonecrosis occurred after treatment of 7 (11%) of the 62 fractures.

Conclusions

Despite timely, excellent reduction and accurate implant placement in the vast majority of cases, the nonunion rate was 19% for fractures treated with cannulated screws alone and 8% for those treated with a fixed-angle device. Although these failure rates are not significantly different, we believe that this study documents the challenging nature of this fracture pattern and the ideal fixation device remains undefined.

Copyright remains with the authors and publisher.

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