Fixation of displaced femoral neck fractures in young adults: Fixed-angle devices or Pauwel screws?

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• 作者：C.M. Hoshino ; M.W. Christian ; R.V. O&rsquo ; Toole ; T.T. Manson ; ^{tmanson@umoa.umm.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Femoral neck fracture ; Fixed-angle device ; Cancellous screw ; Trochanteric lag screw ; Pauwel screw
• 刊名：Injury
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：47
• 期：8
• 页码：1676-1684
• 全文大小：1387 K

文摘

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.