C M Hoshino1, M W Christian1, R V O'Toole1, T T Manson2. 1. R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland Medical Center, 22 S. Greene Street, T3R59, Baltimore, MD 21201, USA. 2. R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland Medical Center, 22 S. Greene Street, T3R59, Baltimore, MD 21201, USA. Electronic address: tmanson@umoa.umm.edu.
Abstract
BACKGROUND: We sought to compare the incidence of complications after fixation of displaced femoral neck fractures in young adults treated with fixed-angle devices versus multiple cancellous screws and a trochanteric lag screw (Pauwel screw). METHODS: We conducted a retrospective cohort study at a level I trauma centre. Sixty-two skeletally mature patients (age range, 16-60 years) with displaced femoral neck fractures were included in the study. Forty-seven were treated with a fixed-angle device (sliding hip plate with screw or helical blade) and 15 with multiple cancellous screws placed in a Pauwel configuration. The main outcome measure was postoperative complication of osteonecrosis or nonunion treated with a surgical procedure. RESULTS: Significantly fewer failures occurred in the fixed-angle group (21%) than in the screws group (60%) (p=0.008). Osteonecrosis was rare in the fixed-angle group, occurring in 2% of cases versus 33% of cases in the screws group (p=0.002). Consistent with previous studies, good to excellent reductions were associated with a failure rate of 25% and fair to poor reductions were associated with a failure rate of 55% (p=0.07). The best-case scenario of a good to excellent reduction stabilised with a fixed-angle device yielded a success rate of 85%. CONCLUSION: In young patients with displaced high-energy femoral neck fractures, fixed-angle devices resulted in fewer treatment failures than did Pauwel screws.
BACKGROUND: We sought to compare the incidence of complications after fixation of displaced femoral neck fractures in young adults treated with fixed-angle devices versus multiple cancellous screws and a trochanteric lag screw (Pauwel screw). METHODS: We conducted a retrospective cohort study at a level I trauma centre. Sixty-two skeletally mature patients (age range, 16-60 years) with displaced femoral neck fractures were included in the study. Forty-seven were treated with a fixed-angle device (sliding hip plate with screw or helical blade) and 15 with multiple cancellous screws placed in a Pauwel configuration. The main outcome measure was postoperative complication of osteonecrosis or nonunion treated with a surgical procedure. RESULTS: Significantly fewer failures occurred in the fixed-angle group (21%) than in the screws group (60%) (p=0.008). Osteonecrosis was rare in the fixed-angle group, occurring in 2% of cases versus 33% of cases in the screws group (p=0.002). Consistent with previous studies, good to excellent reductions were associated with a failure rate of 25% and fair to poor reductions were associated with a failure rate of 55% (p=0.07). The best-case scenario of a good to excellent reduction stabilised with a fixed-angle device yielded a success rate of 85%. CONCLUSION: In young patients with displaced high-energy femoral neck fractures, fixed-angle devices resulted in fewer treatment failures than did Pauwel screws.
Authors: Ashley E Levack; Elizabeth B Gausden; Aleksey Dvorzhinskiy; Dean G Lorich; David L Helfet Journal: J Orthop Trauma Date: 2019-01 Impact factor: 2.512
Authors: Yao Lu; Zhilong Huang; Yibo Xu; Qiang Huang; Cheng Ren; Ming Li; Zhong Li; Liang Sun; Hanzhong Xue; Kun Zhang; Qian Wang; Teng Ma Journal: Am J Transl Res Date: 2022-08-15 Impact factor: 3.940