Fixation of displaced femoral neck fractures in young adults: Fixed-angle devices or Pauwel screws?
BACKGROUND
We sought to compare the incidence of complications after fixation of displaced femoral neck fractures in young adults treated with fixed-angle devices versus multiple cancellous screws and a trochanteric lag screw (Pauwel screw).


METHODS
We conducted a retrospective cohort study at a level I trauma centre. Sixty-two skeletally mature patients (age range, 16-60 years) with displaced femoral neck fractures were included in the study. Forty-seven were treated with a fixed-angle device (sliding hip plate with screw or helical blade) and 15 with multiple cancellous screws placed in a Pauwel configuration. The main outcome measure was postoperative complication of osteonecrosis or nonunion treated with a surgical procedure.


RESULTS
Significantly fewer failures occurred in the fixed-angle group (21%) than in the screws group (60%) (p=0.008). Osteonecrosis was rare in the fixed-angle group, occurring in 2% of cases versus 33% of cases in the screws group (p=0.002). Consistent with previous studies, good to excellent reductions were associated with a failure rate of 25% and fair to poor reductions were associated with a failure rate of 55% (p=0.07). The best-case scenario of a good to excellent reduction stabilised with a fixed-angle device yielded a success rate of 85%.


CONCLUSIONS
In young patients with displaced high-energy femoral neck fractures, fixed-angle devices resulted in fewer treatment failures than did Pauwel screws.
R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland Medical Center, 22 S. Greene Street, T3R59, Baltimore, MD 21201, USA.
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Hoshino
R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland Medical Center, 22 S. Greene Street, T3R59, Baltimore, MD 21201, USA.
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Christian
R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland Medical Center, 22 S. Greene Street, T3R59, Baltimore, MD 21201, USA.
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O'Toole
R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland Medical Center, 22 S. Greene Street, T3R59, Baltimore, MD 21201, USA. Electronic address: tmanson@umoa.umm.edu.
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Manson
D000293:Adolescent; D000328:Adult; D001860:Bone Plates; D001863:Bone Screws; D005260:Female; D005265:Femoral Neck Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods*; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000517:prevention & control / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000000981:diagnostic imaging / Q000517:prevention & control / Q000601:surgery; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011859:Radiography; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
Cancellous screw; Femoral neck fracture; Fixed-angle device; Pauwel screw; Trochanteric lag screw