Results of internal fixation of Pauwels type-3 vertical femoral neck fractures
Results of internal fixation of Pauwels type-3 vertical femoral neck fractures
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DOI：
10.2106/jbjs.g.01353
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发表时间：
2008-08-01
影响因子：
5.3
通讯作者：
Haidukewych, George J.
中科院分区：
文献类型：
--
作者：
Liporace, Frank;Gaines, Robert;Haidukewych, George J.
背景：据推测，骨折线更垂直的股骨颈骨折（即，高Pauwels角）可能会受到更大的剪切力，因此可能倾向于骨不连或固定丧失。尽管对于哪种固定方法是理想的仍存在争议，但据我们所知，没有大型临床系列研究对这些骨折的治疗结果进行评价。这项多中心研究的目的是评价一个大的连续系列的高剪切角（>70 °）股骨颈骨折，以了解更多关于各种内固定策略的结局、并发症和性能。方法：从1993年1月到2005年1月，75例患者中有76例Pauwels 3型（骨科创伤协会[OTA] 31B2.3型）股骨颈骨折，平均年龄为42岁。14例患者失访。61例患者的62处骨折随访至愈合或翻修手术，平均随访时间为24个月。37例骨折采用空心螺钉治疗，25例采用固定角度器械治疗。对复位质量、种植体放置准确性、手术时间、囊袋减压的影响以及骨不连和骨坏死的发生率进行了评估。结果：59例（95%）骨折复位良好，3例复位良好。59例骨折中有8例（14%）骨折不愈合，复位良好，3例骨折中有2例骨折不愈合。动力髋螺钉治疗的1例骨折发生感染性骨不连。37例单纯螺钉固定骨折中有7例（19%）发生无菌性骨不连，而25例采用固定角器械治疗的骨折中有2例（8%）发生无菌性骨不连。治疗后发生骨坏死7（11%）的62 fractions.Conclusions：尽管及时，出色的减少和准确的种植体放置在绝大多数情况下，骨折不愈合率为19%的空心螺钉单独治疗和8%的固定角装置治疗。虽然这些失败率没有显著差异，但我们相信这项研究记录了这种骨折模式的挑战性，理想的固定器械仍不确定。证据等级：治疗级III。证据等级的完整描述见作者说明。
Background: It has been postulated that femoral neck fractures with a more vertical fracture line (i.e., a high Pauwels angle) may experience more shear forces and therefore may be predisposed to nonunion or loss of fixation. Although there is controversy regarding which fixation method is ideal, we are aware of no large clinical series in which the treatment outcomes of these fractures were evaluated. The purpose of this multicenter study was to evaluate a large consecutive series of high shear angle (>70 degrees) femoral neck fractures to learn more about the outcomes, complications, and performance of various internal fixation strategies.Methods: Between January 1993 and January 2005, seventy-six Pauwels type-3 (Orthopaedic Trauma Association [OTA] type-31B2.3) femoral neck fractures were treated in seventy-five patients with a mean age of forty-two years. Fourteen patients were lost to follow-up. Sixty-two fractures in sixty-one patients were followed to union or revision surgery, with a mean duration of follow-up of twenty-four months. Thirty-seven fractures were treated with cannulated screws and twenty-five, with a fixed-angle device. The reduction quality, accuracy of implant placement, time to surgery, influence of capsular decompression, and rates of nonunion and osteonecrosis were evaluated.Results: Fifty-nine (95%) of the fractures had good-to-excel lent reduction, and three had a fair reduction. There was a nonunion of eight (14%) of the fifty-nine fractures with a good-to-excel lent reduction and two of the three with a fair reduction. There was a septic nonunion of one fracture treated with a dynamic hip screw. There was an aseptic nonunion of seven (19%) of the thirty-seven fractures treated with screw fixation alone as compared with two (8%) of the twenty-five fractures treated with a fixed-angle device. Osteonecrosis occurred after treatment of seven (11%) of the sixty-two fractures.Conclusions: Despite timely, excellent reduction and accurate implant placement in the vast majority of cases, the nonunion rate was 19% for fractures treated with cannulated screws alone and 8% for those treated with a fixed-angle device. Although these failure rates are not significantly different, we believe that this study documents the challenging nature of this fracture pattern and the ideal fixation device remains undefined.Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.