The Correlation between the Fracture Types and the Complications after Internal Fixation of the Femoral Neck Fractures

Jo, Suenghwan; Lee, Sang; Lee, Hyeon Jun

doi:10.5371/hp.2016.28.1.35

Cited by 21 publications

(18 citation statements)

References 22 publications

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“…Nonunion is the main complication following internal xation of the femoral neck fractures 18 . The 91% union rate in CMBP group is favorable comparable to the study for Pauwels type III fractures, in which union rates ranging from 73.7-89% 5,12,19,20 .…”

Section: Discussionsupporting

confidence: 69%

The Role of The Medial Buttress Plate In The Treatment of Pauwels Type Ⅱ And Ⅲ Femoral Neck Fracture: A Retrospective Study And Preliminary Results

Liu

et al. 2021

Preprint

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Background: The purpose of this study was to compare the effectiveness of multiple cannulated screws combined with medial buttress plate or not for the treatment of unstable femoral neck fracture.Methods: 69 nonelderly patients with Garden type III-IV femoral neck fracture were retrospectively analyzed. The patients were divided into MCS (multiple cannulated screws) group and CMBP (combined with medial buttress plate) group according to the surgical method. Patient’s demographic data, Harris Hip Score, EQ-5D index and complications at minimum of 2 years follow-up were analyzed.Results: There were 47 patients in the MCS group (35 male and 12 females) with a mean age of 40.28±12.64 years, whereas 22 patients in the CMBP group (17 male and 5 females) with a mean age of 43.86±12.55 years. In the MCS group, there were one avascular necrosis, five postoperative nonunion, five implant failure, and two femoral neck shortening. While one implant failure, two postoperative nonunion and two impingement in the CMBP group. The difference of HHS scores was statistically significant at 3 months after surgery between the two groups (P<0.05), whereas there was no statistical significance at 6 months, 1 year and 2 years (P>0.05). The same results were found in EQ-5D index.Conclusions: Anatomic reduction and stable fixation contribute to satisfactory outcomes in the treatment of nonelderly displaced femoral neck fractures. A buttress plate in the medial region of the femur neck with cannulated screws offers patients the best biomechanical microenvironment needed for fracture healing without obviously blood-supply disruption, especially in Pauwels type Ⅱ and III.

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Section: Discussionsupporting

confidence: 69%

The Role of The Medial Buttress Plate In The Treatment of Pauwels Type Ⅱ And Ⅲ Femoral Neck Fracture: A Retrospective Study And Preliminary Results

Liu

et al. 2021

Preprint

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“…Data on Garden classification were available for the systematic analysis from 14 studies [16–20, 22–24, 26–30, 32]. The fixed effect model was chosen due to nonsignificant heterogeneity in intra-study comparisons ( I 2 = 1%, P = 0.44).…”

Section: Resultsmentioning

confidence: 99%

Risk factors associated with osteonecrosis of femoral head after internal fixation of femoral neck fracture:a systematic review and meta-analysis

Liang

Xiong

et al. 2019

BMC Musculoskelet Disord

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BackgroundAlthough the risk factors associated with osteonecrosis of femoral head (ONFH) after internal fixation of femoral neck fracture (IFFNF) have been frequently reported, the results remain controversial. Therefore, its related risk factors were systematically evaluated and meta-classified in this study.MethodsLiterature on risk factors of ONFH caused by IFFNF was retrieved in PubMed, Embase and Cochrane Library due June 2019. Review Manager 5.3 software was applied to data synthesis, and Stata 13.0 software was adopted for analyses of publication bias and sensitivity.ResultsA total of 17 case-control studies with 2065 patients were included. The risk of ONFH after IF was 0.40-fold higher in patients with Garden III-IV FNF than that in patients with Garden I-II (OR: 0.40, 95%CI: 0.29–0.55). The risk of OFNH with retained IF was uplifted by 0.04 times (OR: 0.04, 95%CI: 0.02–0.07). There was nonsignificant relationship between gender and ONFH after IFFNF (OR: 1.27, 95%CI: 0.84–1.94). Moreover, ONFH after IFFNF presented no association with age (OR:1.66, 95%CI: 0.89–3.11), injury-operation interval (OR:1.29, 95%CI: 0.82–2.04), fracture reduction mode (OR:1.98, 95%CI: 0.92–4.26), preoperative traction (OR:1.69, 95%CI: 0.29–9.98) and mechanism of injury (OR:0.53, 95%CI: 0.06–4.83). Egger’s and Begg’s tests indicated a publication bias (P = 0.001).ConclusionIt was demonstrated that Garden classification and retained IF were important influencing factors of ONFH after IFFNF. Gender, age, injury-operation interval, fracture reduction mode, preoperative traction and the mechanism of ONFH were irrelevant to the complication.

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“…By contrast, a recent study that used a modified method to predict the outcome of femoral neck fractures demonstrated that a highly modified Pauwels angle was a risk factor for non-union [20]. Meanwhile, Jo et al described that the occurrences of non-union in the Pauwels type III fracture, subcapital-type fracture, and Garden stage III and IV fractures were higher than those of other types of femoral neck fracture with statistical significance [32]. Other previous literature found the same phenomenon with regard to the relationship between the Pauwels angle and non-union [14, 33–36].…”

Section: Main Textmentioning

confidence: 99%

An update on the Pauwels classification

et al. 2016

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BackgroundFemoral neck fractures typically occur as a result of high-energy mechanisms among non-geriatric patients. Complications, including femoral neck shortening, non-union, and avascular necrosis, are relatively common after the internal fixation of this fracture pattern. These complications have serious effects on young patients. The Pauwels classification, which is the first biomechanical classification for femoral neck fractures, is still frequently used to determine and prescribe the appropriate treatment for femoral neck fractures. However, we lack a unified standard for measuring the Pauwels angle, which may make the classification unreliable. Understanding the relationship between the Pauwels classification and the complications arising from the internal fixation of femoral neck fractures is necessary. Meanwhile, a Pauwels type III femoral neck fracture among young adults, which involves a high shear load at the fracture site, is difficult to treat successfully. In addition, the recognized internal fixation for this fracture pattern remains uncertain.Main bodyThis review aims to provide an update on the viewpoint on the Pauwels classification including the measurement of the Pauwels angle and to present evidence to prove the aforementioned relationship. Moreover, this article also discusses the optimal internal fixation for femoral neck fractures based on the Pauwels classification.ConclusionA unified standard of measurement should be established for the Pauwels classification, which is still frequently used in the literature and in determining appropriate treatment for femoral neck fractures, to achieve a credible classification. In addition, more randomized, multicentric, and prospective trials should be conducted in the future to clearly understand the relationship between the Pauwels classification and complications arising from the internal fixation of femoral neck fractures and, consequently, to explore ideal fixations for a Pauwels type III femoral neck fracture.

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The Correlation between the Fracture Types and the Complications after Internal Fixation of the Femoral Neck Fractures

Cited by 21 publications

References 22 publications

The Role of The Medial Buttress Plate In The Treatment of Pauwels Type Ⅱ And Ⅲ Femoral Neck Fracture: A Retrospective Study And Preliminary Results

The Role of The Medial Buttress Plate In The Treatment of Pauwels Type Ⅱ And Ⅲ Femoral Neck Fracture: A Retrospective Study And Preliminary Results

Risk factors associated with osteonecrosis of femoral head after internal fixation of femoral neck fracture:a systematic review and meta-analysis

An update on the Pauwels classification

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