Open AccessNovel Treatment Options for the Surgical Management of Young Femoral Neck Fractures
Author(s) -
Ashley E. Levack,
Elizabeth B. Gausden,
Aleksey Dvorzhinskiy,
Dean G. Lorich,
David L. Helfet
Publication year - 2019
Publication title -
journal of orthopaedic trauma
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 121
eISSN - 1531-2291
pISSN - 0890-5339
DOI - 10.1097/bot.0000000000001368
Subject(s) - medicine , nonunion , osteosynthesis , biomechanics , fixation (population genetics) , dynamic hip screw , femoral neck , surgery , orthodontics , internal fixation , anatomy , osteoporosis , population , environmental health , endocrinology
In physiologically young patients with displaced femoral neck fractures, surgical treatment is aimed at achieving fracture union while preserving native hip anatomy and biomechanics. The intracapsular environment, tenuous vascular supply, and unfavorable hip biomechanics contribute to the high complication rates seen after osteosynthesis of these fractures. Conventional fixation methods for osteosynthesis of femoral neck fractures include multiple cancellous screws, fixed-angle dynamic implants, and fixed-angle length-stable constructs. Despite several biomechanical and clinical studies evaluating various surgical options, the optimal fixation construct to allow healing and prevent nonunion of displaced femoral neck fractures is not known. This article will review the clinical data regarding conventional fixation constructs and describe the technique and rationale behind 2 novel alternative treatment options for these challenging fractures. The surgical technique and clinical examples for constructs involving multiple cannulated screws/Pauwels screw augmented with a fibular strut graft, as well as a novel fixed-angle locking plate with controlled dynamic compression, are presented.