Fracture Morphology of High Shear Angle "Vertical" Femoral Neck Fractures in Young Adult Patients

被引:117
作者
Collinge, Cory A. [1 ,2 ]
Mir, Hassan [3 ]
Reddix, Robert [4 ,5 ]
机构
[1] Harris Methodist Ft Worth Hosp, Ft Worth, TX 76104 USA
[2] John Peter Smith Orthoped Surg Residency, Ft Worth, TX USA
[3] Vanderbilt Univ, Sch Med, Dept Orthoped Surg & Rehabil, Nashville, TN 37212 USA
[4] Univ North Texas Hlth Sci Ctr, Dept Orthopaed Surg, Ft Worth, TX USA
[5] John Peter Smith Hosp, Ft Worth, TX 76104 USA
关键词
hip fracture; femoral neck fracture; vertical femoral neck fracture; Pauwels fracture; vertical fracture; young adult; POSTEROMEDIAL FRAGMENT; OPERATIVE TREATMENT; INTERNAL-FIXATION; VARUS COLLAPSE; CLASSIFICATION; COMPLICATIONS; AGES; HIP;
D O I
10.1097/BOT.0000000000000014
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Objective: Management of vertical femoral neck fractures in young adults has been a challenging clinical problem, resulting in mixed clinical outcomes. A thorough understanding of the fracture morphology for this injury pattern is lacking, which may contribute to frequent failures of treatment. This study is designed to produce a detailed description of the pathoanatomy of these fractures, which may ultimately be helpful in developing more informed reduction and fixation strategies. Design: Retrospective study of patient records, plain radiographs, and computed tomography scans to determine the morphology the Pauwels III femoral neck fractures (coronal angle >50 degrees) in young adults. Setting: Two level I and 1 level II regional trauma centers. Patients: All patients 18-49 years of age with a surgically repaired, high-energy high shear angle (>50 degrees) femoral neck fracture from January 1, 2007, to December 31, 2010. Methods: One hundred thirty-six adult patients younger than 50 years were identified with a femoral neck fracture in the study period, of whom 33 met all study criteria. We evaluated plain radiography and computed tomography data including fracture orientation, comminution, deformity, characteristics of the inferomedial fracture spike, and the associated inferomedial calcar's cortical buttress. Results: The vertical (coronal) fracture averaged 60 degrees and axial fracture obliquity averaged 24 degrees with relative deficiency of the posterior neck on the head-neck fragment. Major femoral neck comminution (>1.5 cm in any dimension) was identified in 96% of cases, mostly located in the inferior (94%) and posterior (82%) quadrants. The apical fracture spike of the head segment was found to be in line (within 10 degrees) of the neck-shaft axis on the proximal femur 63% of the time. Deformity in external rotation averaged 44 degrees (range, 10-68 degrees) and shortening of the femur averaged 1.8 cm (range, 0.9-4.4 cm). Conclusions: This study investigated the fracture morphology of isolated, high shear angle femoral neck fractures in young adults, which may ultimately lead to improved operative reduction and fixation tactics. Given this injury's characteristic findings, including fracture orientation, deformity, and comminution, surgeons should be cognizant of this pattern's innate instability and potential for treatment failure with typical implant constructs.
引用
收藏
页码:270 / 275
页数:6
相关论文
共 32 条
  • [1] Alves T., 2010, ORTHOPEDICS, V33, P233, DOI 10.3928/01477447-20100225-07
  • [2] Vertically oriented femoral neck fractures: Mechanical analysis of four fixation techniques
    Aminian, Arash
    Gao, Fan
    Fedoriw, Wasyl W.
    Zhang, Li-Qun
    Kalainov, David M.
    Merk, Bradley R.
    [J]. JOURNAL OF ORTHOPAEDIC TRAUMA, 2007, 21 (08) : 544 - 548
  • [3] [Anonymous], 2009, CLASS DIS INJ
  • [4] Baitner AC, 1999, CLIN ORTHOP RELAT R, P300
  • [5] Frequency and fracture morphology of the posteromedial fragment in bicondylar tibial plateau fracture patterns
    Barei, David P.
    O'Mara, Timothy J.
    Taitsman, Lisa A.
    Dunbar, Robert P.
    Nork, Sean E.
    [J]. JOURNAL OF ORTHOPAEDIC TRAUMA, 2008, 22 (03) : 176 - 182
  • [6] Pauwels' classification of femoral neck fractures:: Correct interpretation of the original
    Bartonícek, J
    [J]. JOURNAL OF ORTHOPAEDIC TRAUMA, 2001, 15 (05) : 358 - 360
  • [7] Catastrophic Failure After Open Reduction Internal Fixation of Femoral Neck Fractures With a Novel Locking Plate Implant
    Berkes, Marschall B.
    Little, Milton T. M.
    Lazaro, Lionel E.
    Cymerman, Rachel M.
    Helfet, David L.
    Lorich, Dean G.
    [J]. JOURNAL OF ORTHOPAEDIC TRAUMA, 2012, 26 (10) : E170 - E176
  • [8] Bonnaire FA, 2002, INJURY, V33, pS24
  • [9] Bray TJ, 1997, CLIN ORTHOP RELAT R, P20
  • [10] COMPLICATIONS OF FEMORAL-NECK FRACTURE IN YOUNG-ADULTS
    DEDRICK, DK
    MACKENZIE, JR
    BURNEY, RE
    [J]. JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1986, 26 (10) : 932 - 937