The effect of anteromedial support plate with three cannulated screws in the treatment of Pauwels type III femoral neck fracture in young adults

Lin, Shanghui; Wang, Renkai; Ou, Yongliang; Jia, Zhenyu; Zhang, Ying; Xia, Hong; Li, Baofeng; Chen, Bei

doi:10.1007/s00068-022-01931-0

Cited by 2 publications

(7 citation statements)

References 31 publications

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“…Two preliminary studies with over 12-month follow-up presented rates of femoral neck shortening from 7.4% to 10.7% using the MBP technique. 16 , 17 Our study verified significant differences between the MBP and TLS groups (7.7% vs. 28.1%) regarding femoral neck shortening and implant failure after an average follow-up time of 46.2 months. At longer follow-up times, the occurrence of this complication in either group was still similar to the short-term results discussed above.…”

Section: Discussionsupporting

confidence: 70%

“…The average operative time was 100.2 minutes, and the average blood loss was 153.1 mL in the MBP group. In previous studies using the MBP technique, Ye 16 reported a mean operative time of 71.4 minutes with a mean blood loss of 270 mL; Lin 17 reported a mean operative time of 89.4 minutes with a mean blood loss of 134.4 mL. In our study, all the fractures were preliminarily reduced on the traction table as emphasized by Lin, 17 and great attention was paid to surgical procedures.…”

Section: Discussionsupporting

confidence: 49%

“… 13 Increased fixation strength may provide the fracture with a favorable mechanical environment to promote healing in vertically unstable fractures. 28 Fractures fixed with MBP-strengthened CSs achieved union rates of 89% and 93%, 16 , 17 whereas the union rate varied from 73% to 93% in fractures fixed with TLS-augmented CSs. 8 , 29 Until now, no comparative studies were found referring to the midterm clinical outcomes of the 2 strategies.…”

Section: Discussionmentioning

confidence: 97%

“…At longer follow-up times, the occurrence of this complication in either group was still similar to the short-term results discussed above. 8 , 16 , 17 It has been found that varus reduction leads to implant failure after proximal femoral nailing. 30 , 31 However, our result showed an equal postoperative varus deformity rate between the 2 groups (0% vs. 9.4%).…”

Section: Discussionmentioning

confidence: 99%

“… 34 However, the rates in our midterm results were higher than those in previous short-term studies, indicating that evaluation of avascular necrosis needs a longer follow-up time. 8 , 16 , 17 , 35 …”

Section: Discussionmentioning

confidence: 99%

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Comparison of augmentation effects of medial buttress plate versus trochanteric lag screw in the cannulated screw fixation of Pauwels type III femoral neck fractures: A retrospective clinical study

2023

AOTT

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Objective: This study aimed to compare the effects of a medial buttress plate (MBP) or a trochanteric lag screw (TLS) to augment cannulated screws (CSs) in fixing Pauwels type III femoral neck fractures. Methods: This retrospective study included 58 patients (21 female, 37 male; mean age = 46 years; age = 19-64 years) treated by CSs for Pauwels type III femoral neck fractures from 2014 to 2017. All the patients were divided into 2 groups based on the internal fixation patterns: the MBP-augmented group (group A, n = 26) and the TLS group (group B, n = 32). The mean age was 47 (range = 24-57) years in group A and 45 (range = 19-64) years in group B. The operation time, intraoperative blood loss, reduction quality, Harris score, and postoperative complications were recorded and compared between both groups. Results: All patients were followed up for an average of 44.8 months in group A and 47.3 months in group B ( P = .406). No significant difference was noted in reduction quality ( P = 1.000). However, group A had a longer operation time (100.2 vs. 64.3 minutes, P < .001) and greater intraoperative blood loss (153.1 vs. 30.0 mL, P < .001) than group B. At the final follow-up, the union rate was equal between group A (96.2%) and group B (90.6%) ( P = .760). The mean bone union time was 21.6 weeks in group A and 23.6 weeks in group B ( P = .431). The delayed union rate was lower in group A (0%) than in group B (15.6%) ( P < .001). The incidence of postoperative complications in terms of implant failure (7.7% vs. 28.1%, P = .048) and femoral neck shortening (7.7% vs. 28.1%, P = .048) were lower in group A than in group B. No significant difference was noted in avascular femoral head necrosis ( P = 1.000) and the Harris score ( P = .659) between the 2 groups. Conclusion: In the surgical treatment of Pauwels type III femoral neck fractures, medial buttress plating can offer fewer complications but equal avascular femoral head necrosis rate and functional outcome compared to trochanteric screw application. Level of Evidence: Level III, Therapeutic study.

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Section: Discussionsupporting

confidence: 70%