Fracture Morphology of High Shear Angle “Vertical” Femoral Neck Fractures in Young Adult Patients

1Director of Orthopedic Trauma, Harris Methodist Fort Worth Hospital, Staff physician John Peter Smith Orthopedic Surgery Residency, Fort Worth, TX 2Assistant Professor, Department of Orthopedic Surgery and Rehabilitation, Vanderbilt University School of Medicine, Nashville, TN 3Associate Professor, Department of Orthopaedic Surgery, University of North Texas Health Science Center, Director of Orthopaedic Trauma, John Peter Smith Hospital, Fort Worth, TX.
Journal of orthopaedic trauma (Impact Factor: 1.8). 10/2013; 28(5). DOI: 10.1097/BOT.0000000000000014
Source: PubMed


Management of vertical femoral neck fractures in young adults has been a challenging clinical problem, resulting in mixed clinical outcomes. A thorough understanding of the fracture morphology for this injury pattern is lacking which may contribute to frequent failures of treatment. This study is designed to produce a detailed description of the pathoanatomy of these fractures, which may ultimately be helpful in developing more informed reduction and fixation strategies.
Retrospective study of patient records, plain radiographs, and computed tomography (CT) scans to determine the morphology the Pauwels III femoral neck fractures (coronal angle >50°) in young adults.
Two level I and one level II regional trauma centers.
All patients 18-49 years of age with a surgically repaired, high-energy high shear angle (> 50°) femoral neck fracture from January 1, 2007, through December 31, 2010.
One hundred and thirty-six adult patients <50 years of age were identified that had a femoral neck fracture in the study period, of which 33 met all study criteria. We evaluated plain radiography and CT data including fracture orientation, comminution, deformity, characteristics of the inferomedial fracture spike and the associated inferomedial calcar's cortical buttress.
The vertical (coronal) fracture averaged 60° and axial fracture obliquity averaged 24° with relative deficiency of the posterior neck on the head-neck fragment. Major femoral neck comminution (>1.5cm in any dimension) was identified in 96% of cases, mostly located in the inferior (94%) and posterior (82%) quadrants. The apical fracture spike of the head segment was found to be in line (within 10°) of the neck-shaft axis on the proximal femur 63% of the time. Deformity in external rotation averaged 44° degrees (range, 10-68°) and shortening of the femur averaged 1.8cm (range, 0.9-4.4cm).
This study investigated the fracture morphology of isolated, high shear angle femoral neck fractures in young adults, which may ultimately lead to improved operative reduction and fixation tactics. Given this injury's characteristic findings, including fracture orientation, deformity, and comminution, surgeons should be cognizant of this pattern's innate instability and potential for treatment failure with typical implant constructs.

13 Reads
  • Source
    • "Injury assume that the Pauwels' angle may be significant in predicting non-union in the younger patient. In addition, a recent study looking at fracture morphology in young high energy femoral neck fractures demonstrated that 96% of patients with a vertical fracture angle (Pauwels 3) had comminution of the posterior femoral neck, a factor that has previously been associated with non union [12]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Femoral neck non union is a relatively uncommon complication following intracapsular hip fracture in the young patient. Almost all patients with femoral neck non union are symptomatic for which they will require some form of revision surgery. This review discusses the role of valgus osteotomy in managing the younger patient with femoral neck non union. Copyright © 2014 Elsevier Ltd. All rights reserved.
    Injury 12/2014; 46(3). DOI:10.1016/j.injury.2014.11.022 · 2.14 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Femoral neck fractures account for nearly half of all hip fractures with the vast majority occurring in elderly patients after simple falls. Currently there may be sufficient evidence to support the routine use of hip replacement surgery for low demand elderly patients in all but non-displaced and valgus impacted femoral neck fractures. However, for the physiologically young patients, preservation of the natural hip anatomy and mechanics is a priority in management because of their high functional demands. The biomechanical challenges of femoral neck fixation and the vulnerability of the femoral head blood supply lead to a high incidence of non-union and osteonecrosis of the femoral head after internal fixation of displaced femoral neck fractures. Anatomic reduction and stable internal fixation are essentials in achieving the goals of treatment in this young patient population. Furthermore, other management variables such as surgical timing, the role of capsulotomy and the choice of implant for fixation remain controversial. This review will focus both on the demographics and injury profile of young patients with femoral neck fractures and the current evidence behind the surgical management of these injuries as well as their major secondary complications.
    World Journal of Orthopaedics 07/2014; 5(3):204-17. DOI:10.5312/wjo.v5.i3.204
  • [Show abstract] [Hide abstract]
    ABSTRACT: Femoral neck fractures in physiologically young adults are relatively uncommon. The reported incidence of avascular necrosis and nonunion rates remain relatively high despite the advancement in understanding and surgical management. Understanding the normal femoral neck anatomy and its relationship to presenting fracture pathology in young adults could help to lessen reported high complication rates to provide better clinical outcomes. Copyright © 2014 Elsevier Ltd. All rights reserved.
    Injury 11/2014; 46(3). DOI:10.1016/j.injury.2014.11.017 · 2.14 Impact Factor
Show more

Similar Publications