Results of Internal Fixation of Pauwels Type-3 Vertical Femoral Neck Fractures

Liporace, Frank A.; Gaines, Robert J.; Collinge, Cory; Haidukewych, George J.

doi:10.2106/jbjs.g.01353

Cited by 315 publications

(260 citation statements)

References 15 publications

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“…These cases benefit most from open reduction and valgus osteotomy with or without fibular grafting. Higher Pauwelstype fractures have a greater chance of failure and varus collapse [12,17]. It has been suggested that such fracture nonunions are best treated by valgus osteotomy to improve biomechanics at the fracture site [12].…”

Section: Discussionmentioning

confidence: 99%

Osteosynthesis of femoral-neck nonunion with angle blade plate and autogenous fibular graft

Sen

Trıpathy²,

Goyal³

et al. 2011

International Orthopaedics (SICOT)

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Angle blade plate provides rigid stability and offloads any shearing force over the fibular graft when used for revision internal fixation in aseptic femoral-neck nonunion. Thus, the fibular graft only serves the purpose of osteogenesis and stimulates the surrounding host cells to promote healing at the nonunion site. We recommend the angle blade plate and autogenous fibular graft as a viable option for hip-joint salvage in revision internal fixation of aseptic femoral-neck nonunion.

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Section: Discussionmentioning

confidence: 99%

Osteosynthesis of femoral-neck nonunion with angle blade plate and autogenous fibular graft

Sen

Trıpathy²,

Goyal³

et al. 2011

International Orthopaedics (SICOT)

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“…Aminian et al [21], in a cadaveric study, found that the proximal femoral locking plate is the strongest construct for stabilizing a vertical shear femoral neck fracture, whereas three cannulated screws comprise the weakest construct; however, the nature of these fracture patterns makes them more susceptible to varus, shortening, and nonunion [22].…”

Section: Discussionmentioning

confidence: 99%

Treatment of nonunion of femoral neck fracture by valgus osteotomy in 33 cases

Norouzi

Alami-Harandi

Naderi³

2009

Eur J Trauma Emerg Surg

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In spite of advances in treatment, femoral neck fractures are complicated fractures with a relatively high incidence of nonunion. Between 1990 and 2004, 33 patients with nonunion of femoral neck fractures were treated by valgus osteotomy in our department. The mean age of patients at the time of operation was 38 years (range 16-60 years). Reasons for nonunion were implant failure in 21 and osteomalacia in two patients. The remaining ten patients were treated nonoperatively. Average neck-shaft angle was 109° (78°-125°), and the average shortening of the involved limb was 2.5 cm (0.5-4.5). After subtrochanteric valgus osteotomy, fracture healing occurred in 32 of 33 patients. The average time for healing was five months (range 3-8 months). Pain and limitation of motion improved remarkably, and the majority of patients did not need to use crutches. Postoperatively, the neckshaft angle was 140° (125°-160°), and shortening reduced to an average of 1 cm. Partial avascular necrosis of the femoral head developed in five patients after 6-12 months. Valgus osteotomy of the femur is a suitable procedure for treatment of femoral neck nonunion in young patients, since it is easy to perform and yields relatively good results.

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“…However, in a retrospective review, 23% of patients treated with parallel screws developed nonunion or avascular necrosis compared to 59% of those treated with crossed/Pauwel screws [15]. In a subgroup analysis of the study by Liporace et al, mechanical failure occurred in 60% of fractures fixed with crossed/Pauwel screws compared to 13% of those fixed with parallel screws [16]. Another departure from the traditional inverted triangle configuration is the use of triangular parallel screws, which feature 2 inferior screws and 1 superior screw.…”

Section: Biomechanical Studiesmentioning

confidence: 98%

“…Liporace et al performed a retrospective review of 62 young (age range 19-64) patients with mostly displaced vertical femoral neck fractures [16]. These authors compared a heterogeneous group of fixed angle devices to a heterogeneous group of screw configurations.…”

Section: Clinical Studies: Comparativementioning

confidence: 99%