The role of the medial buttress plate in the treatment of Pauwels type II and III femoral neck fracture in nonelderly patients: a retrospective study and preliminary results

Abstract

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 in nonelderly patients. Methods Sixty-nine 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 a 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 1 (2.1%) avascular necrosis, 5 (10.6%) postoperative nonunion, 5 (10.6%) implant failure, and 2 (4.3%) femoral neck shortening. While 1 (4.5%) implant failure, 2 (9.1%) postoperative nonunion and 2 (9.1%) impingement in the CMBP group. For patients with Pauwels type II and III femoral neck fracture, the CMBP group had higher HHS scores at 3 months after surgery than the MCS group (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 the EQ-5D index. Conclusions In our cohort, we observed better outcomes in the CMBP group at 3 and 6 months, with later results similar between groups. However, there were fewer complications in the CMBP group, without obviously blood-supply disruption, especially in Pauwels type II and III. Further, anatomic reduction and stable fixation may contribute to satisfactory outcomes in the treatment of nonelderly displaced femoral neck fractures.

Femoral neck system vs. cannulated screws on treating femoral neck fracture: a meta-analysis and system review

“…A total of 16 studies analyzed the fracture healing time ( 6 – 10 , 13 – 19 , 21 , 23 , 27 , 28 ) and reported 1,007 cases in total (467 in FNS and 540 in CCS). There was a strong heterogeneity among the studies ( I 2 = 94% > 50%, P < 0.05).…”

Finite Element Analysis of Six Internal Fixations in the Treatment of Pauwels Type III Femoral Neck Fracture

“…Our study found that the CCS + MBP model had an optimally initial mechanical stability when compared to other five internal fixations. Previous biomechanical and clinical studies had suggested that, in contrast to the use of CCS alone, CCS + MBP maintained sliding compression and anti‐rotation capabilities, while also directly resisting shear stress, contributing to a more favorable prognosis for the treatment of Pauwels type III fractures 39,40 . However, because of intricate anatomical positioning, the placement of MBP medially of the femoral neck posed significant challenges, potentially leading to joint capsule damage or hip impingement 41,42 .…”

Research hotspots and trends in internal fixation of femoral neck fractures from 2010 to 2022: A 12-year bibliometric analysis

“…Although bone plates have demonstrated their efficacy in resisting shear forces and reducing displacement, [20–22] they have not shown improved long-term outcomes. [23,24] Additionally, bone plates can pose challenges and disadvantages, such as difficulty in achieving accurate reduction and fixation, increased risk of infection, bleeding, malalignment, nerve injury, or hardware irritation. Although biomechanical analyses of bone plates hold significant importance, Various studies have recently been conducted to determine the optimal bone plate device.…”