Abstract

Background: Femoral neck fractures with a more vertical fracture line (i.e., a high Pauwels’ angle) have been studied to experience more shear forces and therefore are predisposed to nonunion or loss of fixation. Although no consensus about an ideal fixation method is known, we are aware of no clinical series in North India in which the treatment outcomes of these fractures were evaluated. The purpose of this single-center prospective study was to evaluate a series of high shear angle (>70) femoral neck fractures in young adults and to study and compare the outcomes, complications, and performance of various internal fixation strategies.

Methods: Between January 2014 and December 2016, we admitted and subsequently treated twenty -five Pauwels’ type-3 (Orthopaedic Trauma Association [OTA] type-31B2.3) femoral neck fractures in twenty-five patients with a mean age of twenty-three years. All patients were followed to union with a mean duration of follow-up of eighteen months. Fourteen fractures were treated with cannulated screws and eleven with a fixed-angle device. The reduction quality, accuracy of implant placement, time to surgery, influences of capsular decompression, and rates of nonunion and osteonecrosis were evaluated.
Results: Sixteen (64%) of the fractures had good-to-excellent reduction, and five had a fair reduction. There was a nonunion of one (6%) of the sixteen fractures with a good-to-excellent reduction and two of the five with a poorreduction. There was an aseptic nonunion of four (28%) of the fourteen fractures treated with screw fixation alone as compared with one  (9%) of the eleven fractures treated with a fixed-angle device. Osteonecrosis occurred after treatment of four (16%) of the twenty-five fractures.

Conclusions: We got anonunion in 28% for fractures treated with cannulated screws alone and 9% for those treated with a fixed-angle device. This was inspite of the fact that we achieved a good fracture reduction and implant placement in most of the cases.  Even though our results match with previously reported studies, our study highlights this difficult fracture and the most ideal implant still remains elusive. 

Level of Evidence: Therapeutic Level III.