title: Preoperative decision making in the treatment of high-angle "vertical" femoral neck fractures in young adult patients. An expert opinion survey of the Orthopaedic Trauma Association's (OTA) membership.
abstract: OBJECTIVE
  To identify the current implant and diagnostic imaging preferences among orthopaedic trauma experts for the treatment of high-energy vertical femoral neck fractures in young adult patients.
  
  
  METHODS
  Web-based survey.
  
  
  METHODS
  Not available.
  
  
  METHODS
  Active members of the OTA.
  
  
  METHODS
  A cross-sectional expert opinion survey was administered to the active members of the OTA to determine their preferences for implant use and imaging in the surgical treatment of a vertical femoral neck fracture in a young adult patient (e.g., 60-degree Pauwels angle fracture in a healthy 30-year-old patient). Questions were also asked regarding the reason why this implant was selected, whether the surgeon felt that their choice was supported by the literature, and what imaging studies are routinely obtained to guide decision making. Data were collected using simple multiple-choice questions and/or a 5-point Likert item.
  
  
  RESULTS
  Two hundred seventy-two surgeons (47%) responded to the survey. The preferred constructs for a vertical femoral neck fracture in a healthy young patient were a sliding hip screw with or without an anti-rotation screw (47%), parallel cannulated screws with an off-axis screw (28%), and parallel cannulated screw constructs (15%). When asked if their designated construct "was clearly supported by the literature," 46% were either unsure or disagreed. Seventy percent of surgeons chose their preferred implant because it was "biomechanically most stable." Most surgeons required anteroposterior pelvis (70%) and standard hip (88%) radiographs; however only 29% of surgeons required a computed tomography (59% found computed tomography helpful but not required). Twenty-seven percent of surgeons have changed their implant choice intraoperatively.
  
  
  CONCLUSIONS
  Femoral neck fractures in young adult patients are a challenging problem with high rates of failed treatment. Many options for treatment exist and a consensus on the best method remains elusive. Our survey demonstrates the diversity and disagreement among OTA member "expert" orthopaedic traumatologists for the "best" treatment choice for this important clinical scenario. Our survey shows a divided level of confidence in the current literature and highlights the need for further study of this problem.
  
  
  METHODS
  Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *John Peter Smith Hospital, University of North Texas Health Science Center, Fort Worth, TX; †San Antonio Military Medical Center (SAMMC), San Antonio, TX; and ‡Harris Methodist Fort Worth Hospital, Fort Worth, TX.
authors.forename: Kevin
authors.initials: K
authors.lastname: Luttrell
authors.forename: Michael
authors.initials: M
authors.lastname: Beltran
authors.forename: Cory A
authors.initials: CA
authors.lastname: Collinge
mesh_terms: D000328:Adult; D001863:Bone Screws / Q000592:standards; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D005265:Femoral Neck Fractures / Q000000981:diagnostic imaging* / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000592:standards*; D019538:Health Care Surveys; D006801:Humans; D020407:Internet; D011300:Preoperative Care; D011859:Radiography