Comparative Analysis of Supplemental Medial Buttress Plate Fixation for High-Energy Displaced Femoral Neck Fractures in Young Adults. Issue 5 (May 2023)

• Record Type: Journal Article
• Authors: Collinge, Cory A.; Harris, Payton; Sagi, H. Claude; Rodriguez-Buitrago, Andres; Beltran, Michael J.; Mitchell, Phillip M.; Mir, Hassan R.; Lebus, George F.; Tornetta, Paul; de la Fuente, Guadalupe
• Other Names: Archdeacon Michael collaborator.; Gardner Michael collaborator.; Cannada Lisa K. collaborator.; Streufert Ben collaborator.; Robinette Patton collaborator.; O'Neill David collaborator.; Olszewski Nathan collaborator.; Sems Andrew collaborator.; Jeray Kyle collaborator.; Cardin Poza Stefano collaborator.; Tanner Stephanie collaborator.; Avilucea Frank collaborator.; Schumaier Adam collaborator.; Ketz John collaborator.; Hedgecock Jon collaborator.; Coles Chad collaborator.; Trask Kelly collaborator.; Macdonald Shelley collaborator.; Scolaro John collaborator.; Bustillo David collaborator.; Crist Brett D. collaborator.; Horner Kevin collaborator.; Bergin Patrick collaborator.; Miles Daniel T. collaborator.; Spitler Clay collaborator.; Ahn Jaimo collaborator.; Bram Joshua T. collaborator.; Morris Tyler collaborator.; Hsu Joseph collaborator.; Buck J. Stewart collaborator.; Schmidt Andrew collaborator.; Westberg J.R. collaborator.; Tejwani Nirmal collaborator.; Mehta Devan collaborator.; Virkus Walter collaborator.; Harrington Justin collaborator.; Weber Timothy collaborator.; Flint Kathy collaborator.; Mullis Brian collaborator.; Lancaster Alex collaborator.; Liporace Frank collaborator.; Adams Don collaborator.; Horwitz Daniel collaborator.; Yaacobi Eyal collaborator.; Hymes Robert collaborator.; Kilcoyne Kelly collaborator.; Cannada Lisa K. collaborator.; Lusk Dominic collaborator.;
• Is Part Of: Journal of orthopaedic trauma. Volume 37:Issue 5(2023)
• Page Start: 207
• Page End: 213
• Publication Date: 2023-05
• Subjects: medial plate -- buttress -- plate -- femoral neck -- fracture -- young -- Pauwels -- Smith-Petersen; Orthopedics -- Periodicals; Wounds and injuries -- Periodicals; Orthopedics -- Periodicals; Wounds and Injuries -- therapy -- Periodicals; Periodicals; 617.47044
• DOI: 10.1097/BOT.0000000000002578
• Languages: English
• ISSNs: 0890-5339

Abstract

Abstract : Supplemental Digital Content is Available in the Text. Abstract : Objectives: To evaluate whether augmenting traditional fixation with a femoral neck buttress plate (FNBP) improves clinical outcomes in young adults with high-energy displaced femoral neck fractures. Design: Multicenter retrospective matched cohort comparative clinical study. Setting: Twenty-seven North American Level 1 trauma centers. Patients: Adult patients younger than 55 years who sustained a high-energy (nonpathologic) displaced femoral neck fracture. Intervention: Operative reduction and stabilization of a displaced femoral neck fracture with (group 1) and without (group 2) an FNBP. Main Outcome Measurements: Complications including failed fixation, nonunion, osteonecrosis, malunion, and need for subsequent major reconstructive surgery (early revision of reduction and/or fixation), proximal femoral osteotomy, or arthroplasty. Results: Of 478 patients younger than 55 years treated operatively for a displaced femoral neck fracture, 11% (n = 51) had the definitive fixation augmented with an FNBP. One or more forms of treatment failure occurred in 29% (n = 15/51) for group 1 and 49% (209/427) for group 2 ( P < 0.01). When FNBP fixation was used, mini-fragment (2.4/2.7 mm) fixation failed significantly more often than small-fragment (3.5 mm) fixation (42% vs. 5%, P < 0.01). Irrespective of plate size, anterior and anteromedial plates failed significantly more often than direct medial plates (75% and 33% vs. 9%, P < 0.001). Conclusions: The use of a femoral neck buttress plate to augment traditional fixation in displaced femoral neck fractures is associated with improved clinical outcomes, including lower rates of failed fixation, nonunion, osteonecrosis, and need for secondary reconstructive surgery. The benefits of this technique are optimized when a small-fragment (3.5 mm) plate is applied directly to the medial aspect of the femoral neck, avoiding more anterior positioning . Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.