Closed or open reduction, Medial buttress plate augmentation, Unstable fracture neck of femur in young adults,Cannulated cancellous screw fixation
Citation Information :
Singaravadivelu V, Kartheesan G, Sampathkumar V. Unstable Fracture Neck of Femur in Young Adults: Management with Cannulated Cancellous Screws Augmented with Medial Buttress Plate. 2019; 1 (1):1-4.
Objective: This study is to evaluate the clinical and radiological outcome of unstable fracture neck of the femur in young adults treated with three cannulated cancellous screws augmented with medial buttress plate.
Materials and methods: Fifteen patients of less than 60 years were operated from January 2017 to March 2018. Reduction was achieved by closed or open means to Garden\'s alignment index grade I. Internal fixation was done with three cannulated cancellous screws through mini lateral incision, and medial buttress plating was done through modified Smith–Peterson approach. All patients were mobilized from the immediate postoperative period and allowed toe-touch weight-bearing as tolerated. All patients were followed at 2 weeks, 6 weeks, 3 months, 6 months, and 12 months postoperatively.
Results: Fracture united in 14 of 15 patients. Reduction loss and backing out of cancellous screws occurred in one patient. No cases of avascular necrosis was identified at a mean follow-up of 13.7 months. No significant femoral neck shortening was observed in all united fractures.
Conclusion: Anatomical reduction by closed or open method; stable fixation with three cannulated cancellous screws augmented with medial buttress plate, increases fracture union rate compared to the historical series using closed reduction and cancellous screw fixation alone. Open reduction and medial antiglide plate fixation do not appear to increase morbidity.
Robinson CM, Court-Brown CM, McQueen MM, et al. Hip fractures in adults younger than 50 years of age, epidemiology and results. Clin Orthop Relat Res 1995;312:238–246.
Pauwels F. Der Schenkelhalsbruch: Elin Mechanisches problem. Stuttgart: Ferdinand Enke Verlag; 1935.
Dedrick DK, Mackenzie JR, Burney RF. Complications of femoral neck fractures in young adults. J Trauma 1986;26(10):932–937. DOI: 10.1097/00005373-198610000-00013.
Kofoed H. Femoral neck fractures in young adults. Injury 1982;14(2):146–150. DOI: 10.1016/0020-1383(82)90049-3.
Liporace F, Gaines R, Collinge C, et al. Results of internal fixation of Pauwels type 3 vertical femoral neck fractures. J Bone Joint Surg Am 2008;90(8):1654–1659. DOI: 10.2106/JBJS.G.01353.
Garden RS. Stability and union in sub capital fractures of the femur. J Bone Joint Surg Br 1964;46:630–647. DOI: 10.1302/0301-620X.46B4.630.
Collinge CA, Mir H, Reddix R. Fracture morphology of high shear angle “vertical” femoral neck fractures in young adult patients. J Orthop Trauma 2014;28(5):270–275. DOI: 10.1097/BOT. 0000000000000014.
Schwartsmann CR, de Oliveira GK, de Oliveira RK, et al. The real fracture of femoral neck. Acta Ortop Bras 2000;8(3):108–111. DOI: 10.1590/S1413-78522000000300002.
Mir H, Collinge C. Application of a medial buttress plate may prevent many treatment failures seen after fixation of vertical femoral neck fractures in young adults. Med Hypotheses 2015;84(5):429–433. DOI: 10.1016/j.mehy.2015.01.029.
Kunapuli SC, Schramski MJ, Lee AS, et al. Bio mechanical analysis of augmented plate fixation for the treatment of vertical shear femoral neck fractures. J Orthop Trauma 2015;29(3):144–150. DOI: 10.1097/BOT.0000000000000205.
Razik F, Alexopoulos AS, El-Osta B, et al. Time to internal fixation of femoral neck fractures in patients under sixty years - Does this matter in the development of osteonecrosis of femoral head. Int Orthop 2012;36(10):2127–2132. DOI: 10.1007/s00264-012-1619-1.
Ghayoumi P, Kandemir U, Morshed S. Evidence based update: open versus closed reduction. Injury 2015;46(3):467–473. DOI: 10.1016/j.injury.2014.10.011.
Slobogean GP, Sprague SA, Scott T, et al. Complications following young femoral neck fractures. Injury 2015;46(3):484–491. DOI: 10.1016/j.injury.2014.10.010.
Ye Y, Chen K, Tian K, et al. Medial buttress plate augmentation of cannulated screw fixation in vertically unstable femoral neck fractures. Injury 2017;48(10):2189–2193. DOI: 10.1016/j.injury.2017.08.017.