Fracture Morphology of High Shear Angle "Vertical" Femoral Neck Fractures in Young Adult Patients
Fracture Morphology of High Shear Angle "Vertical" Femoral Neck Fractures in Young Adult Patients
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DOI：
10.1097/bot.0000000000000014
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发表时间：
2014-05-01
影响因子：
2.3
通讯作者：
Reddix, Robert
中科院分区：
文献类型：
--
作者：
Collinge, Cory A.;Mir, Hassan;Reddix, Robert
目的：年轻人垂直型股骨颈骨折的治疗一直是一个具有挑战性的临床问题，导致临床结局不一。缺乏对这种损伤模式的骨折形态的透彻理解，这可能导致治疗的频繁失败。本研究的目的是详细描述这些骨折的病理解剖结构，这可能最终有助于制定更明智的复位和固定策略。设计：回顾性研究患者记录，平片和计算机断层扫描，以确定Pauwels III型股骨颈骨折的形态（冠状角>50度）。设置：两个I级和一个II级区域创伤中心。患者：所有患者年龄为18-49岁，手术修复，高能量高剪切角方法：选择2007年1月1日至2010年12月31日在我院就诊的50岁以下股骨颈骨折患者136例，其中33例符合标准。我们评估了平片和计算机断层扫描数据，包括骨折的方向，粉碎，畸形，特点的下内侧骨折钉，和相关的下内侧距的皮质buttress.Results：垂直（冠状）骨折平均60度和轴向骨折平均24度，相对不足的头颈部碎片的后颈部。在96%的病例中发现了严重的股骨颈粉碎（任何尺寸>1.5 cm），主要位于下象限（94%）和后象限（82%）。63%的情况下，发现股骨头节段的顶端骨折尖峰与股骨近端的颈干轴线成一直线（10度以内）。外旋畸形平均为44度（范围，10-68度），股骨缩短平均为1.8 cm（范围，0.9-4.4 cm）。结论：本研究调查了年轻成人孤立性高剪切角股骨颈骨折的骨折形态，这可能最终导致手术复位和固定策略的改进。考虑到这种损伤的特征性表现，包括骨折方向、畸形和粉碎，外科医生应该认识到这种类型的先天不稳定性和典型植入物结构治疗失败的可能性。
Objective:Management of vertical femoral neck fractures in young adults has been a challenging clinical problem, resulting in mixed clinical outcomes. A thorough understanding of the fracture morphology for this injury pattern is lacking, which may contribute to frequent failures of treatment. This study is designed to produce a detailed description of the pathoanatomy of these fractures, which may ultimately be helpful in developing more informed reduction and fixation strategies.Design:Retrospective study of patient records, plain radiographs, and computed tomography scans to determine the morphology the Pauwels III femoral neck fractures (coronal angle >50 degrees) in young adults.Setting:Two level I and 1 level II regional trauma centers.Patients:All patients 18-49 years of age with a surgically repaired, high-energy high shear angle (>50 degrees) femoral neck fracture from January 1, 2007, to December 31, 2010.Methods:One hundred thirty-six adult patients younger than 50 years were identified with a femoral neck fracture in the study period, of whom 33 met all study criteria. We evaluated plain radiography and computed tomography data including fracture orientation, comminution, deformity, characteristics of the inferomedial fracture spike, and the associated inferomedial calcar's cortical buttress.Results:The vertical (coronal) fracture averaged 60 degrees and axial fracture obliquity averaged 24 degrees with relative deficiency of the posterior neck on the head-neck fragment. Major femoral neck comminution (>1.5 cm in any dimension) was identified in 96% of cases, mostly located in the inferior (94%) and posterior (82%) quadrants. The apical fracture spike of the head segment was found to be in line (within 10 degrees) of the neck-shaft axis on the proximal femur 63% of the time. Deformity in external rotation averaged 44 degrees (range, 10-68 degrees) and shortening of the femur averaged 1.8 cm (range, 0.9-4.4 cm).Conclusions:This study investigated the fracture morphology of isolated, high shear angle femoral neck fractures in young adults, which may ultimately lead to improved operative reduction and fixation tactics. Given this injury's characteristic findings, including fracture orientation, deformity, and comminution, surgeons should be cognizant of this pattern's innate instability and potential for treatment failure with typical implant constructs.