TITLE

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

AUTHOR(S)
Liporace, Frank; Gaines, Robert; Gollinge, Gory; Haidukewych, George J.
PUB. DATE
August 2008
SOURCE
Journal of Bone & Joint Surgery, American Volume;Aug2008, Vol. 90-A Issue 8, p1654
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
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°) femoral neck fractures to learn more about the outcomes, complications, and performance of various internal fixation strategies. Methods: Between January 1993 and January 2005, seventy-six Pauwels type-3 (Orthopaedic Trauma Association [OTA] type-31B2.3) femoral neck fractures were treated in seventy-five patients with a mean age of forty-two years. Fourteen patients were lost to follow-up. Sixty-two fractures in sixty-one patients were followed to union or revision surgery, with a mean duration of follow-up of twenty-four months. Thirty-seven fractures were treated with cannulated screws and twenty-five, 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: Fifty-nine (95%) of the fractures had good-to-excellent reduction, and three had a fair reduction. There was a nonunion of eight (14%) of the fifty-nine fractures with a good-to-excellent reduction and two of the three with a fair reduction. There was a septic nonunion of one fracture treated with a dynamic hip screw. There was an aseptic non-union of seven (19%) of the thirty-seven fractures treated with screw fixation alone as compared with two (8%) of the twenty-five fractures treated with a fixed-angle device. Osteonecrosis occurred after treatment of seven (11%) of the sixty-two 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. Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.
ACCESSION #
34412594

 

Related Articles

  • Variability in the Assessment of Fracture-Healing in Orthopaedic Trauma Studies. Corrales, Luis A.; Morshed, Saam; Bhandari, Mohit; Miclau, III, Theodore // Journal of Bone & Joint Surgery, American Volume;Sep2008, Vol. 90-A Issue 9, p1862 

    Background: There is a lack of consensus among orthopaedic surgeons in the assessment of fracture-healing. We conducted a systematic review of recent clinical studies of long-bone fracture care that were published in three major orthopaedic journals to identify current definitions of...

  • Femoral Nerve Block for Diaphyseal and Distal Femoral Fractures in the Emergency Department. Mutty, Christopher E.; Jensen, Erik J.; Manka Jr., Michael A.; Anders, Mark J.; Bone, Lawrence B. // Journal of Bone & Joint Surgery, American Volume;Oct2008 Supplement 2, Vol. 90-A, p218 

    BACKGROUND: Diaphyseal and distal femoral fractures are painful injuries that are frequently seen in patients requiring a trauma work-up in the hospital emergency department prior to definitive management. The purpose of this study was to determine whether a femoral nerve block administered in...

  • Balloon reduction and cement fixation in intra-articular calcaneal fractures: a percutaneous approach to intra-articular calcaneal fractures. Jacquot, Frederic; Atchabahian, Arthur // International Orthopaedics;Jul2011, Vol. 35 Issue 7, p1007 

    Purpose: The management of calcaneal fractures remains challenging and often controversial. Open reduction and internal fixation with a lateral plate has been established as a standard therapy for displaced articular fractures. However, accurate subtalar joint reduction, while mandatory, is...

  • Fracturas periprotésicas de cadera. Sauri-Arce, J. C. A.; Azcona-Cervera, R. // Acta Ortopedica Mexicana;Mar/Apr2014, Vol. 28 Issue 2, p77 

    The incidence rate of peripros-thetic fractures has increased in the past decade. Osteolysis, age and preoperative function are factors that influence morbidity. Treatment options include conservative and surgical treatment. Objectives: To conduct a study analyzing the functional results of the...

  • Function Plateaus by One Year in Patients With Surgically Treated Displaced Midshaft Clavicle Fractures. Schemitsch, Laura; Schemitsch, Emil; Veillette, Christian; Zdero, Rad; McKee, Michael // Clinical Orthopaedics & Related Research;Dec2011, Vol. 469 Issue 12, p3351 

    Background: Based on short-term (1 year or less) followup, primary fixation of displaced midshaft clavicle fractures reportedly results in better function compared with that reported for nonoperative methods. Whether better function persists beyond 1 year is unclear. Questions/purposes: For...

  • Management of Acute Distal Humeral Fractures in Patients with Rheumatoid Arthritis. Jost, Bernhard; Adams, Robert A.; Morrey, Bernard F. // Journal of Bone & Joint Surgery, American Volume;Oct2008, Vol. 90-A Issue 10, p2197 

    Background: The best surgical treatment for a patient with rheumatoid arthritis and an acute distal humeral fracture is not well established. Because of the distorted anatomy of the arthritic elbow joint and the adjacent osteoporotic bone, total elbow arthroplasty may be favored over open...

  • Distal Tibial Reconstruction with Use of a Circular External Fixator and an Intramedullary Nail. Eralp, Levent; Kocaoglu, Mehmet // Journal of Bone & Joint Surgery, American Volume;Oct2008 Supplement 2, Vol. 90-A, p181 

    BACKGROUND: Distal tibial reconstruction with use of an external fixator when there is bone loss, limb-length discrepancy, and/or ankle instability is associated with many problems. The technique of limb-lengthening, ankle arthrodesis, and segmental transfer over an intramedullary nail has been...

  • Thoracolumbar Burst Fractures Treated with Posterior Decompression and Pedicle Screw Instrumentation Supplemented with Balloon-Assisted Vertebroplasty and Calcium Phosphate Reconstruction. Marco, Rex A. W.; Kushwaha, Vivek P. // Journal of Bone & Joint Surgery, American Volume;Jan2009, Vol. 91-A Issue 1, p20 

    Background: The treatment of unstable thoracolumbar burst fractures with short-segment posterior spinal instrumentation without anterior column reconstruction is associated with a high rate of screw breakage and progressive loss of reduction. The purpose of the present study was to evaluate the...

  • Operative Management of Distal Radial Fractures with 2.4-Millimeter Locking Plates: A Multicenter Prospective Case Series. Jupiter, Jesse B.; Marent-Huber, M. // Journal of Bone & Joint Surgery, American Volume;Jan2009, Vol. 91-A Issue 1, p55 

    Background: In the past decade, there has been a trend toward open reduction and internal fixation of unstable distal radial fractures. There are now more than thirty different implant designs specific for the fixation of distal radial fractures. A multicenter prospective study of a case series...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics