*Harris Methodist Fort Worth Hospital, Fort Worth, TX; †John Peter Smith Orthopedic Surgery Residency, Fort Worth, TX; ‡Department of Orthopedic Surgery and Rehabilitation, Vanderbilt University School of Medicine, Nashville, TN; §Department of Orthopaedic Surgery, University of North Texas Health Science Center, Fort Worth, TX; and ‖John Peter Smith Hospital, Fort Worth, TX.
J Orthop Trauma. 2014 May;28(5):270-5. doi: 10.1097/BOT.0000000000000014.
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 scans to determine the morphology the Pauwels III femoral neck fractures (coronal angle >50 degrees) in young adults.
Two level I and 1 level II regional trauma centers.
All patients 18-49 years of age with a surgically repaired, high-energy high shear angle (>50 degrees) femoral neck fracture from January 1, 2007, to December 31, 2010.
One hundred thirty-six adult patients younger than 50 years were identified with a femoral neck fracture in the study period, of whom 33 met all study criteria. We evaluated plain radiography and computed tomography 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 degrees and axial fracture obliquity averaged 24 degrees with relative deficiency of the posterior neck on the head-neck fragment. Major femoral neck comminution (>1.5 cm 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 degrees) of the neck-shaft axis on the proximal femur 63% of the time. Deformity in external rotation averaged 44 degrees (range, 10-68 degrees) and shortening of the femur averaged 1.8 cm (range, 0.9-4.4 cm).
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.
年轻成人股骨颈垂直骨折的治疗一直是一个具有挑战性的临床问题，导致临床结果不一。对于这种损伤模式，我们对骨折形态的了解还不够，这可能导致治疗失败的情况经常发生。本研究旨在详细描述这些骨折的病理解剖结构，这最终可能有助于制定更明智的复位和固定策略。
回顾性研究患者病历、普通 X 线片和 CT 扫描，以确定年轻成人 Pauwels III 型股骨颈骨折（冠状角>50 度）的形态。
两个 I 级和 1 个 II 级区域创伤中心。
2007 年 1 月 1 日至 2010 年 12 月 31 日期间，年龄在 18-49 岁之间、接受手术修复的高能量高剪切角（>50 度）股骨颈骨折的所有患者。
在研究期间，确定了 136 名年龄小于 50 岁的成人股骨颈骨折患者，其中 33 名符合所有研究标准。我们评估了普通 X 线片和 CT 数据，包括骨折方向、粉碎程度、畸形、内侧骨折刺的特征以及内侧骺板皮质支撑的情况。
垂直（冠状）骨折平均为 60 度，轴向骨折倾斜度平均为 24 度，头颈部骨折块的后颈部相对不足。96%的病例存在主要的股骨颈粉碎（任何方向>1.5 厘米），主要位于下（94%）和后（82%）象限。头部节段的顶端骨折刺与股骨近端的颈干轴在同一直线上（相差 10 度以内），这种情况占 63%。外旋畸形平均为 44 度（范围 10-68 度），股骨缩短平均为 1.8 厘米（范围 0.9-4.4 厘米）。
本研究调查了年轻成人孤立性高剪切角股骨颈骨折的骨折形态，这最终可能导致手术复位和固定策略的改善。鉴于这种损伤的特征性表现，包括骨折方向、畸形和粉碎程度，外科医生应该认识到这种骨折的固有不稳定性和潜在的治疗失败风险，特别是使用常规的植入物结构。
