Does the Watson-Jones or Modified Smith-Petersen Approach Provide Superior Exposure for Femoral Neck Fracture Fixation?

Abstract

Open reduction and internal fixation of a femoral neck fracture is typically performed in a young patient (< 60 years old) with the objective of obtaining anatomic reduction that would not be possible by closed manipulation, thus enhancing healing potential. In the hands of surgeons experienced in both approaches, the modified Smith-Petersen approach offers improved direct access for reduction and fixation. Higher quality reductions and fixation are expected to translate to improved healing potential and outcomes. Although our experimental results are promising, further clinical studies are needed to verify if this larger exposure area imparts increased quality of reduction, healing, and improved outcomes compared with other approaches. The learning curve for the exposure is unclear, but the approach has broad applications and is frequently used in other subspecialties such as for direct anterior THA and pediatric septic hip drainage. Surgeons treating femoral neck fractures with open reduction and fixation should familiarize themselves with the modified Smith-Petersen approach.

Neglected Neck of Femur Fracture Managed by Surgical Hip Dislocation: A Case Report and Literature Review

“…Hereby, ORIF was found to be the most appropriate surgical intervention. The exposure for ORIF can be achieved by two classical surgical approaches; the modified Smith-Peterson (i.e., anterior approach) and Watson Jones (i.e., anterolateral approach) [ 2 , 7 , 8 ]. A larger exposure to the proximal femur is provided by the Smith-Petersen compared to the Watson-Jones approach, enabling better assessment and more accurate fracture fixation [ 8 ].…”

Abordaje de Smith Petersen modificado para fracturas de cuello femoral Pauwels III – Garden IV

“…Aunque es fácil su reinserción al finalizar el procedimiento quirúrgico se desconoce su real morbilidad. 16 Fig. 5 (A) TC a las 6 semanas de evolución demuestra la reducción anatómica de la fractura (flecha) y la adecuada posición de los tornillos.…”

CORR Insights®: Does the Watson-Jones or Modified Smith-Petersen Approach Provide Superior Exposure for Femoral Neck Fracture Fixation?

“…The former is still unproven, and the latter is unknown. The current study by Lichstein and colleagues [5] provides useful information regarding which exposure provides better visualization of the femoral neck and articular surface. This can be useful in planning fixation of both femoral neck and head fractures.…”