Comparative Analysis of Supplemental Medial Buttress Plate Fixation for High-Energy Displaced Femoral Neck Fractures in Young Adults

Collinge, Cory; Harris, Payton; Sagi, Henry Claude; Rodriguez-Buitrago, Andres; Beltran, Michael J.; Mitchell, Phillip M.; Mir, Hassan R.; Lebus, George F.; Tornetta, Paul; Fuente, Guadalupe de la

doi:10.1097/bot.0000000000002578

Cited by 2 publications

(3 citation statements)

References 37 publications

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“…The surgical management of displaced femoral neck fractures in young and middle-aged patients is fraught with challenges and high rates of treatment failure despite recent developments in surgical strategies and techniques. 1–7 A recent report on clinical outcomes using the database evaluated in this study showed that complications and treatment failure remain extremely common in this patient population. 1 An ongoing area of interest for surgeons tasked with managing these injuries is whether the choice of fixation influences the likelihood of treatment failure.…”

Section: Introductionmentioning

confidence: 85%

“…1 An ongoing area of interest for surgeons tasked with managing these injuries is whether the choice of fixation influences the likelihood of treatment failure. 1,2,5,[8][9][10][11] Historical constructs for the management of these injuries have typically included a fixed-angle (FA) device (ie, sliding hip screw [SHS] or the use of multiple cannulated screws [MCS]). More recent reports have emphasized the addition of socalled antirotation (AR) screws or femoral neck buttress plate Accepted for publication April 26, 2024.…”

Section: Introductionmentioning

confidence: 99%

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Optimal Fixation Strategies for Displaced Femoral Neck Fractures in Patients 18–59 Years of Age: An Analysis of 565 Cases Treated at 26 Level 1 Trauma Centers

Roser,

Collinge,

Giga

et al. 2024

Journal of Orthopaedic Trauma

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OBJECTIVES: To determine the difference in failure rates of surgical repair for displaced femoral neck fractures in patients less than 60 years of age according to fixation strategy. METHODS: Design: Retrospective, comparative cohort study Setting: 26 level 1 North American trauma centers Patient Selection Criteria: Patients less than 60 years of age with a displaced femoral neck fracture (OTA 31-B2, B3) undergoing surgical repair from 2005 to 2017 Outcome Measures and Comparisons: Patient demographics, injury characteristics, repair methods utilized, and treatment failure (nonunion/ failed fixation, avascular necrosis, and need for secondary surgery) were compared according to fixation strategy. RESULTS: Five hundred and sixty-five patients met inclusion criteria and were studied. The mean age was 42 years, 36% were female, and the average Pauwels’ angle of fractures was 55°. There were 305 patients treated with multiple cannulated screws (MCS) and 260 treated with a fixed-angle (FA) construct. Treatment failures were 46% overall, but was more likely to occur in MCS constructs vs. FA devices (55% vs. 36%, p<0.001). When FA constructs were sub-stratified, the use of a sliding hip screw (SHS) with addition of a medial femoral neck buttress plate (FNBP) and “antirotation” (AR) screw demonstrated better results than either FNBP or AR screw alone or neither with the lowest overall construct failure rate of 11%(p<0.036) CONCLUSIONS: Historically used fixation constructs for femoral neck fractures (e.g. multiple cannulated screws and sliding hip screw) in young and middle-aged adults performed poorly compared to more recently proposed constructs, including those utilizing a medial femoral neck buttress plate and an anti-rotation screw. Fixed angle constructs outperformed multiple cannulated screws overall, and augmentation of fixed angle constructs with a medial femoral neck buttress plate and antirotation screw improved the likelihood of successful treatment. Surgeons should prioritize fixation decisions when repairing displaced femoral neck fractures in patients.

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Section: Introductionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Optimal Fixation Strategies for Displaced Femoral Neck Fractures in Patients 18–59 Years of Age: An Analysis of 565 Cases Treated at 26 Level 1 Trauma Centers

Roser,

Collinge,

Giga

et al. 2024

Journal of Orthopaedic Trauma

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“…A multicentre study, led by surgeons from Fort Worth (Texas, USA) , included patients from 27 North American level one trauma centres, and the authors examined the outcomes of 478 patients aged younger than 55 years. 5 The cohort were all treated operatively following presentation with a displaced femoral neck fracture. As would of course be expected from a retrospective study of this nature, the groups were not even, and 11% (n = 51) also had the fixation augmented with a femoral neck buttress plate.…”

Section: Young Hip Fractures: Is a Medial Buttress The Answer?mentioning

confidence: 99%

Trauma

2023

Bone &Amp; Joint 360

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The June 2023 Trauma Roundup360 looks at: Aspirin or low-molecular-weight heparin for thromboprophylaxis?; Lateral plating or retrograde nailing for distal femur fractures?; Sciatic nerve palsy after acetabular fixation: what about patient position?; How reliable is the new OTA/AO classification for trochanteric hip fractures?; Young hip fractures: is a medial buttress the answer?; When is the best time to ‘flap’ an open fracture?; The mortality burden of nonoperatively managed hip fractures.

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Comparative Analysis of Supplemental Medial Buttress Plate Fixation for High-Energy Displaced Femoral Neck Fractures in Young Adults

Abstract: Objectives: To evaluate whether augmenting traditional fixation with a femoral neck buttress plate (FNBP) improves clinical outcomes in young adults with high-energy displaced femoral neck fractures.

Cited by 2 publications

References 37 publications

Optimal Fixation Strategies for Displaced Femoral Neck Fractures in Patients 18–59 Years of Age: An Analysis of 565 Cases Treated at 26 Level 1 Trauma Centers

Optimal Fixation Strategies for Displaced Femoral Neck Fractures in Patients 18–59 Years of Age: An Analysis of 565 Cases Treated at 26 Level 1 Trauma Centers

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