Orthopedic Department, The Affiliated Lihuili Hospital of Ningbo University, 1111 JiangNan Road, Ningbo, 315040, China.
Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 YiShan Road, Shanghai, 200233, China.
BMC Musculoskelet Disord. 2024 Jan 29;25(1):100. doi: 10.1186/s12891-024-07207-5.
A understanding of morphological characteristics are important to femoral neck fractures (FNFs) resulting in high rates of complications in the young and middle-aged adults and the detailed data is lack in the literature. We aimed to report on the detailed morphological characteristics and the relationship between them in young and middle-aged adults with femoral neck fractures (FNFs).
The postoperative CT images of one hundred and fifty-two adults with FNFs were retrospectively reviewed. After image standardization, morphological characteristics including fracture orientation, cortex comminution, and intraosseous bone defects were measured and analyzed. Additionally, the distribution and correlation of these morphological features were analyzed using Pauwels classification, the right angle of the neck axis (VNA) classification, and the anteromedial oblique angle (AMA).
Pauwels III fractures accounted for approximately half (55.2%) of the FNFs analyzed. Pauwels II and III could be detected in all four VNA types, and the distribution of the Pauwels types in VNA classification showed significant differences (χ = 106.363, p < 0.001). The VNA (9.0° ± 12.1) showed positive correlation with the neck-shaft angle (139.5° ± 6.3) and modified Pauwels angle (49.8° ± 10.6) (r = 0.441, r = 0.855, all p < 0.001). Cortical comminutions were commonly observed in the posterior (86.7%) and the inferior (80.7%). AMAs within the cases without posterior and inferior cortex comminutions were significantly larger than those with comminution (t = 2.594, 2.1196; p = 0.01, 0.036), but no difference could be detected after the AMA being divided into three groups (< 85°, 85°-95°, > 95°). The MPA, VNA and AMA of the group with an intraosseous defect were significantly different compared with those without (t = 2.847, 2.314, 2.268; p = 0.005, 0.022,0.025). The incidence of intraosseous defects within the groups with coronal and axial cortex comminutions were significantly higher than those within the groups without comminutions (χ = 34.87, 25.303; p < 0.001).
The present study highlights the morphological diversity and complexity within FNFs in young and middle-aged adults, which allows for more accurate simulation of FNF patterns in the future biomechanical studies.
了解股骨颈骨折（FNF）的形态学特征对于年轻和中年人群中高并发症发生率至关重要，但文献中缺乏详细数据。我们旨在报告年轻和中年股骨颈骨折（FNF）患者的详细形态学特征及其之间的关系。
回顾性分析了 152 例 FNF 成年患者的术后 CT 图像。在图像标准化后，测量并分析了骨折方向、皮质粉碎和骨内骨缺损等形态特征。此外，还使用 Pauwels 分类、颈干角（VNA）分类和前内侧斜角（AMA）分析了这些形态特征的分布和相关性。
Pauwels III 型骨折约占分析的 FNF 的一半（55.2%）。在所有 4 种 VNA 类型中都可以检测到 Pauwels II 和 III 型，VNA 分类中 Pauwels 型的分布差异有统计学意义（χ=106.363，p<0.001）。VNA（9.0°±12.1）与颈干角（139.5°±6.3）和改良 Pauwels 角（49.8°±10.6）呈正相关（r=0.441，r=0.855，均 p<0.001）。皮质粉碎常见于后（86.7%）和下（80.7%）方。无后皮质和下皮质粉碎的 AMA 明显大于粉碎组（t=2.594，2.1196；p=0.01，0.036），但在 AMA 分为三组后（<85°、85°-95°、>95°）则无差异。伴有骨内缺损组的 MPA、VNA 和 AMA 与无缺损组有显著差异（t=2.847，2.314，2.268；p=0.005，0.022，0.025）。冠状和轴向皮质粉碎组的骨内缺损发生率明显高于无粉碎组（χ=34.87，25.303；p<0.001）。
本研究强调了年轻和中年人群中 FNF 的形态多样性和复杂性，这使得未来的生物力学研究能够更准确地模拟 FNF 模式。
