OTA 2012 Posters

Scientific Poster #13 Hip/Femur OTA-2012

Morphology of Displaced Paewels III Vertical Femoral Neck Fractures in Young Adults

Cory A. Collinge, MD1,2; Robert N. Reddix, Jr., MD2;
1Harris Methodist Fort Worth Hospital, Fort Worth, Texas, USA;
2John Peter Smith Orthopedic Surgery Residency, Fort Worth, Texas, USA

Purpose: Management of vertical femoral neck fractures in young adults has been challenging and resulted in mixed clinical outcomes. 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 this fracture, which may be helpful in forming reduction and fixation strategies for these injuries.

Methods: This is a retrospective study of patient records and radiography of patients <60 years of age with a displaced vertical Paewels III femoral neck fracture that was surgically repaired at one of two adjacent regional trauma centers (one Level I, one Level II) from January 2007 to December 2010. Patients with ipsilateral femoral or acetabular fractures were excluded. 22 patients underwent preoperative CT; these data were reviewed in multiple planes and assessed for fracture angle, deformity, comminution, and competence of the calcar’s cortical buttress.

Results: The average vertical fracture measured 61° (range, 52°-78°) on coronal CT and the average fracture obliquity of the head-neck fragment on axial CT measured 38° (range, 8°-61°) with relative deficiency of the posterior neck in all cases. All patients had external rotation deformity that averaged 44° (range, 10°-68°) and shortening of the femur averaging 2.1 cm (range, 0.9-4.4 cm). Femoral neck comminution >1.5 cm in any dimension was identified in 95% of cases, mostly posteriorly (94%) and inferiorly (94%). A competent calcar cortex estimated to predictably buttress a well-placed inferior lag screw was seen in only 9 of 19 (47%) cases.

Conclusions: This study investigated the fracture morphology of Paewels III vertical femoral neck fractures in young adults, which may facilitate improved results of operative reduction and fixation. Given the high frequency of 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.

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.