Clinical observation of medial-buttress-plate augmentation of cannulated-screw fixation through direct anterior approach for the treatment of Pauwels Ⅲ femoral neck fracture
Gen Dawei, Chen Sichun, Jiang Longhai, Qin Jian
Department of Orthopedics, Sir Run Run Hospital, Nanjing Medical University, Nanjing 211166, China
Abstract：Objective This study aimed to investigate the effects of medial-buttress-plate augmentation of cannulated-screw fixation through direct anterior approach (DAA) for the treatment of Pauwels Ⅲfemoral neck fracture.Methods A total of 24 patients with Pauwels Ⅲ femoral neck fracture who were admitted in Sir Run Run Hospital from Spetember 2016 to September 2018 were retrospectively analyzed. The patients were divided into two groups according to different surgical techniques. The control group was treated with closed reduction and three cannulated screws, whereas the observation group was treated through DAA open reduction and cannulated screws combined with a medial-buttress plate. The observation group comprised 11 cases, including 7 males and 4 females, aged 19-55(39.91±12.37)years. The control group comprised 13 cases, including 7 males and 6 females aged 18-54(41.23±11.31)years. The Harris hip function score, fracture healing time, and incidence of complications (e.g.,fracture nonunion, internal fixation failure, avascular necrosis of femoral head, Garden alignment index, and Haidukewych femoral neck fracture reduction quality) were compared between the two groups at 6 months and 1 year after surgery.Results No statistically significant difference in baseline data was observed between the two groups (all P values＞0.05).All patients were followed-up for 1 year. The Harris hip score in the observation group [(85.18±5.88) and (92.18±4.17) points] was higher than that in the control group [(72.92± 6.26) and (88.38±6.17) points] at 6 and 12 months after surgery. The difference was significant at 6 months (P＜0.01) but not at 12 months (P＞0.05). The average healing time of fracture in the observation group was 3.23-6.06 (4.45 ± 0.88) months, which was lower than that in the control group 3.86-7.93(5.77±1.17) months(P＜0.01).The observation group had no postoperative complications, whereas the control group had 5 postoperative complications out of 13 cases (P=0.041). No differences in Garden alignment index and Haidukewych femoral neck fracture reduction quality were observed between the two groups (all P values＞0.05).Conclusions Compared with multiple cancellous screws for Pauwels III femoral neck fracture, a medial-buttress plate combined with cannulated compression screws through DAA can effectively reduce postoperative complications, thereby allowing patients to exercise early and facilitate the recovery of hip function. Clinical observation of a medial buttress plate augmentation of cannulated screw fixation with direct anterior approach in the treatment of Pauwels Ⅲ femoral neck fracture.
耿大伟, 陈思春, 江龙海, 覃健. 直接前侧入路切开复位空心螺钉联合内侧支撑钢板固定治疗Pauwels Ⅲ型股骨颈骨折的疗效观察[J]. 中华解剖与临床杂志, 2020, 25(5): 503-507.
Gen Dawei, Chen Sichun, Jiang Longhai, Qin Jian. Clinical observation of medial-buttress-plate augmentation of cannulated-screw fixation through direct anterior approach for the treatment of Pauwels Ⅲ femoral neck fracture. Chinese Journal of Anatomy and Clinics, 2020, 25(5): 503-507.
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2020, Vol. 25 
