Using a modified Pauwels method to predict the outcome of femoral neck fracture in relatively young patients

Wang, Shenghao; Yang, Jui-Jung; Shen, Hsain-Chung; Lin, Leou-Chyr; Lee, Meei-Shyuan

doi:10.1016/j.injury.2015.06.016

Cited by 64 publications

(65 citation statements)

References 25 publications

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“…Similar results in which the Pauwels angle was not related to non-union risk were found in other studies [27–31]. By contrast, a recent study that used a modified method to predict the outcome of femoral neck fractures demonstrated that a highly modified Pauwels angle was a risk factor for non-union [20]. Meanwhile, Jo et al described that the occurrences of non-union in the Pauwels type III fracture, subcapital-type fracture, and Garden stage III and IV fractures were higher than those of other types of femoral neck fracture with statistical significance [32].…”

Section: Main Textsupporting

confidence: 81%

“…The lack of a unified standard for measuring the Pauwels angle may make the Pauwels classification unreliable. The Pauwels angle, which consists of two lines (the horizontal line and the fracture line of the distal fragment) could be easily changed when the preoperative radiographs were taken because of the different positions of the leg, such as rotation and abduction [17, 19, 20]. The mutability of these two lines (the horizontal line and the fracture line of the distal fragment) in the radiographs can result in inaccuracy of the classification.…”

Section: Main Textmentioning

confidence: 99%

“…Therefore, the key to solving this problem is to set a unified standard for measuring the Pauwels angle which can confirm the aforementioned two lines. Recently, several studies have described a modification of the original Pauwels method [20, 21]. They used the anatomic axis of the femoral shaft as a guideline; then, they defined an imaginary line perpendicular to this guideline.…”

Section: Main Textmentioning

confidence: 99%

“…In the AVN of the femoral head after the internal fixation of the femoral neck fracture, which is catastrophic for patients, Wang et al indicated that higher modified Pauwels angles demonstrated significant differences with respect to AVN [20]. However, only a few studies have focused on the relationship between the Pauwels angle and AVN.…”

Section: Main Textmentioning

confidence: 99%

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An update on the Pauwels classification

et al. 2016

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BackgroundFemoral neck fractures typically occur as a result of high-energy mechanisms among non-geriatric patients. Complications, including femoral neck shortening, non-union, and avascular necrosis, are relatively common after the internal fixation of this fracture pattern. These complications have serious effects on young patients. The Pauwels classification, which is the first biomechanical classification for femoral neck fractures, is still frequently used to determine and prescribe the appropriate treatment for femoral neck fractures. However, we lack a unified standard for measuring the Pauwels angle, which may make the classification unreliable. Understanding the relationship between the Pauwels classification and the complications arising from the internal fixation of femoral neck fractures is necessary. Meanwhile, a Pauwels type III femoral neck fracture among young adults, which involves a high shear load at the fracture site, is difficult to treat successfully. In addition, the recognized internal fixation for this fracture pattern remains uncertain.Main bodyThis review aims to provide an update on the viewpoint on the Pauwels classification including the measurement of the Pauwels angle and to present evidence to prove the aforementioned relationship. Moreover, this article also discusses the optimal internal fixation for femoral neck fractures based on the Pauwels classification.ConclusionA unified standard of measurement should be established for the Pauwels classification, which is still frequently used in the literature and in determining appropriate treatment for femoral neck fractures, to achieve a credible classification. In addition, more randomized, multicentric, and prospective trials should be conducted in the future to clearly understand the relationship between the Pauwels classification and complications arising from the internal fixation of femoral neck fractures and, consequently, to explore ideal fixations for a Pauwels type III femoral neck fracture.

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Section: Main Textsupporting

confidence: 81%

Section: Main Textmentioning

confidence: 99%

Section: Main Textmentioning

confidence: 99%

Section: Main Textmentioning

confidence: 99%

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An update on the Pauwels classification

et al. 2016

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“…[13,14] Both ONFH and nonunion are notorious complications, although great endeavor has been made in past decades, the prognosis of femoral neck fractures in the young is not improved fundamentally.…”

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

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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.

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