Valgus Osteotomy for Delayed Presentation of Femoral Neck Fractures Pauwels Grade III

The present study was to analyze clinical outcome of Pauwels grade-3 femoral neck fractures treated by different surgical techniques. Potential risk factors associated with nonunion and osteonecrosis of the femoral head (ONFH) were investigated as well. The retrospective study comprised of 67 sequential patients treated between January 2008 and December 2011. Patients with Pauwels grade-3 femoral neck fractures were treated by operative reduction and internal fixation. Cannulated screws (CS) were used in 46 patients, dynamic hip screw plus CS (DHS+CS) in 14, and locking compression plate (LCP) for proximal femur in 7. Reduction quality was assessed according to Haidukewych criteria. Postoperative radiographic examinations were conducted to observe fracture healing. Fracture displacement, comminution, fashion of internal fixation, and the sliding effect were analyzed, regarding the incidence of nonunion and ONFH. All patients had a follow-up of 21.6 ± 6.0 months on average. The phenomenon of sliding effect was observed in 16 cases (23.9%). In terms of reduction quality, 64 cases were graded as excellent, 2 were good, and 1 was poor. ONFH was presented in 15 cases (22.4%) and nonunion was found in 8 (11.9%), with 1 patient had ONFH and nonunion concomitantly. Profound hip contour was preserved in 45 cases (67.2%). The fashion of internal fixation yielded different results regarding ONFH and nonunion, whereas the effects of fracture displacement, comminution, and the sliding effect were not significant. ONFH and nonunion were common complications following Pauwels grade-3 femoral neck fractures. Higher incidence of ONFH in DHS+CS and of nonunion in the LCP group should be noted.

show abstract

“…Consequently, the shearing stress could also turn into compressive force, which is favorable to fracture healing. [16,17] …”

Section: Discussionmentioning

confidence: 99%

Osteonecrosis of the femoral head, nonunion and potential risk factors in Pauwels grade-3 femoral neck fractures

Zhang

Chen

et al. 2016

Medicine

View full text Add to dashboard Cite

show abstract

“…In underdeveloped areas, however, it is not rare to see patients after a delay of several months because of poverty, lack of facilities, ignorance and faith in traditional bonesetters (1)(2)(3)(4)(5)(6). In addition, femoral neck fractures concomitant with ipsilateral femoral shaft fractures are sometimes missed initially leading to a delay in treatment (7,8).…”

Section: Introductionmentioning

confidence: 99%

“…In addition, femoral neck fractures concomitant with ipsilateral femoral shaft fractures are sometimes missed initially leading to a delay in treatment (7,8). Femoral neck fractures may be considered neglected when no proper medical treatment has been initiated within one Free vascularised fibular graft for neglected femoral neck fractures in young adults month following the fracture (1)(2)(3)(4)(5)(6). Such patients usually don't have a history of surgical intervention.…”

Section: Introductionmentioning

confidence: 99%

“…Prosthetic replacement generally is the preferred treatment for patients older than 60 years, while attempts to salvage of the femoral head are generally favoured for younger patients. A variety of surgical procedures, such as valgus osteotomy (1,2,6), muscle pedicle bone graft (10,11) or periosteal graft (12,13), nonvascularised bone graft (3,4,14) and…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Free Vascularised Fibular Graft for Neglected Femoral Neck Fractures in Young Adults

et al. 2012

View full text Add to dashboard Cite

Neglected femoral neck fractures in young adults pose a great challenge to orthopedic surgeons because of the high risks of nonunion and osteonecrosis. We attempted to determine whether free vascularised fibular grafting through an anterior approach could enhance bone union, improve hip function and reduce complications in the treatment of such fractures. Thirteen patients with neglected femoral neck fractures were treated with a free vascularised fibular graft through an anterior approach between 2004 and 2008. The mean age was 30.9 years (range, 17-47 years). The average delay between injury and operation was 6.7 months (range, 1.5-22 months). All 13 cases had ununited fractures but without osteonecrosis of the femoral head on plain radiographs before coming under our care. The average follow-up was 51.2 months (range, 36-75 months). All patients had fracture union within an average of 4.8 months (range, 3-9 months). Postoperatively, 9 patients had coxa vara of 10 to 20 degrees and leg discrepancy between 0.5 to 1.5 cm. One patient had coxa vara deformity of 25 degrees and 2-cm leg discrepancy. No patients developed osteonecrosis of the femoral head or donor-site morbidity. The mean Harris hip score improved from 55.5 points preoperatively to 84.8 points postoperatively (p<0.01). This procedure may be useful and safe in the treatment of neglected femoral neck fractures in young adults, but further studies with a large number of patients are needed.

show abstract

“…18 The valgus angulation osteotomy used to treat nonunion is usually performed in the subtrochanteric or intertrochanteric regions, and is more efficient than the displacement osteotomy in converting shearing forces at the fracture site into compressive ones and improving rates of union. 2 The biological basis of this is a presumed increase in blood flow and so AVN is not a contraindication for valgus osteotomy. 21 The angulation osteotomy can also simultaneously correct rotational and limb length discrepancies.…”

Section: Discussionmentioning

confidence: 99%

Meta analysis of different methods used for joint preserving procedures in the management of delayed, neglected and non-united femoral neck fractures in young adults

Elzohairy

Eid

2016

Trauma

View full text Add to dashboard Cite

Background: Neglected fractures in young adults can be amongst the most difficult to treat in the spectrum of fractures of the femoral neck. Because of its complex anatomy and blood supply, timely fixation is paramount. When this does not occur, non-union and avascular necrosis are common complications. Here, we present a meta-analysis of three common options available to the surgeon treating such complications. Methods: We identified 97 relevant papers by the keywords 'femoral neck fractures'; 'neglected'; 'joint preserving' and 'young adults'; 23 met the inclusion criteria and reported on an overall population of 725 patients. Results: Osteotomy with internal fixation had a union rate of 91.33% (95% CI 84.91-92.87). Fractures fixed by internal fixation with pedicled muscle graft proceeded to union in 86.25% (95% CI 78.92%-88.54%) of cases and those managed with free fibular graft in 88% (95% CI 78.35%-90.84%), respectively. Internal fixation alone, in this study, used as an illustrative control group, was successful in 76.5% (95% CI 65.58%-83.81%) of cases. Conclusion: These findings show superiority of osteotomy with internal fixation in the management of non-united femoral neck fractures, and more complex options with potentially higher morbidity confer no patient benefit.

show abstract

Valgus Osteotomy for Delayed Presentation of Femoral Neck Fractures Pauwels Grade III

Cited by 12 publications

References 23 publications

Osteonecrosis of the femoral head, nonunion and potential risk factors in Pauwels grade-3 femoral neck fractures

Osteonecrosis of the femoral head, nonunion and potential risk factors in Pauwels grade-3 femoral neck fractures

Free Vascularised Fibular Graft for Neglected Femoral Neck Fractures in Young Adults

Meta analysis of different methods used for joint preserving procedures in the management of delayed, neglected and non-united femoral neck fractures in young adults

Contact Info

Product

Resources

About