Surgical Approaches for Femoral Neck Fractures: A Review Article
Abstract
Displaced femoral neck fractures in the young are difficult to treat. The complexity of the fractures for closed or open reduction requires careful surgical planning and experience. Acceptable reduction criteria in this fracture is crucial and should be followed strictly in order to get the favorable outcomes. Various reduction techniques have been described ranging from closed reduction by traction table or closed reduction with minimal direct manipulation with instruments to direct open reduction. This manuscript describes the mini open reduction, Watson-Jones and Smith-Petersen approaches, and some modifications in terms of indications, advantages, and disadvantages of each approach for the decision-making in these complex fractures.
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2. Najafi A, Tavakoli M, Zargar D, Hadavi D, Seif E, Azarsina S. Valgus impacted femoral neck fractures: Surgery or non-operative approach?. J Orthop Spine Trauma. 2021;7(2):39-43. doi: 10.18502/jost.v7i2.6998.
3. Siavashi B, Heshmati M, Golbakhsh MR, Shafiei SH, Mahdavi F, Sadeghi M, et al. A web-based dynamic nomogram to calculate the risk of nonhealing after femoral neck fracture fixation among young adults: Bench to bedside translational research.
J Orthop Spine Trauma. 2022;7(3):85-94. doi: 10.18502/jost.v7i3.8104.
4. Kurylo JC, Templeman D, Mirick GE. The perfect reduction: Approaches and techniques. Injury. 2015;46(3):441-4. doi: 10.1016/j.injury.2014.11.027. [PubMed: 25616674].
5. Slobogean GP, Sprague SA, Scott T, McKee M, Bhandari M. Management of young femoral neck fractures: Is there a
consensus? Injury. 2015;46(3):435-40. doi: 10.1016/j.injury.2014.11.028. [PubMed: 25530411].
6. Garden RS. Malreduction and avascular necrosis in subcapital fractures of the femur. J Bone Joint Surg Br. 1971;53(2):183-97. [PubMed: 5578215].
7. Reikeras O, Gunderson RB. Cross table lateral radiography for measurement of acetabular cup version. Ann Transl Med. 2016;4(9):169. doi: 10.21037/atm.2016.05.08. [PubMed: 27275482]. [PubMed Central: PMC4876262].
8. Lowell JD. Results and complications of femoral neck fractures. Clin Orthop Relat Res. 1980;(152):162-72. [PubMed: 7438599].
9. Ding DY, Mahure SA, Mollon B, Shamah SD, Zuckerman JD, Kwon YW. Comparison of general versus isolated regional anesthesia in total shoulder arthroplasty: A retrospective propensity-matched cohort analysis. J Orthop. 2017;14(4):417-24. doi:
10.1016/j.jor.2017.07.002. [PubMed: 28794581]. [PubMed Central: PMC5537444].
10. Florschutz AV, Langford JR, Haidukewych GJ, Koval KJ. Femoral neck fractures: current management. J Orthop Trauma. 2015;29(3):121-9. doi: 10.1097/BOT.0000000000000291. [PubMed: 25635363].
11. Rhorer AS. Percutaneous/minimally invasive techniques in treatment of femoral shaft fractures with an intramedullary nail. J Orthop Trauma. 2009;23(5 Suppl):S2-S5. doi: 10.1097/BOT.0b013e31819f2569. [PubMed: 19390371].
12. Chua D, Jaglal SB, Schatzker J. Predictors of early failure of fixation in the treatment of displaced subcapital hip fractures.
J Orthop Trauma. 1998;12(4):230-4. doi: 10.1097/00005131-199805000-00002. [PubMed: 9619456].
13. Duckworth AD, Bennet SJ, Aderinto J, Keating JF. Fixation of intracapsular fractures of the femoral neck in young patients: risk factors for failure. J Bone Joint Surg Br. 2011;93(6):811-6. doi: 10.1302/0301-620X.93B6.26432. [PubMed: 21586782].
14. Lichstein PM, Kleimeyer JP, Githens M, Vorhies JS, Gardner MJ, Bellino M, et al. Does the Watson-Jones or modified Smith-Petersen approach provide superior exposure for femoral neck fracture fixation? Clin Orthop Relat Res. 2018;476(7):1468-76. doi: 10.1097/01.blo.0000533627.07650.bb. [PubMed: 29698292].
[PubMed Central: PMC6437565].
15. Singh K, Weitlich JD, Zitsch BP, Schweser KM, Cook JL, Crist BD. Which surgical approach provides maximum visualization and access for open reduction and internal fixation (ORIF) of femoral neck fractures? Injury. 2022;53(3):1131-6. doi: 10.1016/j.injury.2021.11.023. [PubMed: 34809924].
16. Patterson JT, Ishii K, Tornetta P, Leighton RK, Friess DM, Jones CB, et al. Smith-Petersen versus Watson-Jones approach does not
affect quality of open reduction of femoral neck fracture. J
Orthop Trauma. 2021;35(10):517-22. doi:
10.1097/BOT.0000000000002068. [PubMed: 34510125].
17. Molnar RB, Routt ML. Open reduction of intracapsular hip fractures using a modified Smith-Petersen surgical exposure. J
Orthop Trauma. 2007;21(7):490-4. doi:
10.1097/BOT.0b013e31804a7f7f. [PubMed: 17762484].
18. Blair JA, Stinner DJ, Kirby JM, Gerlinger TL, Hsu JR. Quantification of femoral neck exposure through a minimally invasive Smith-Petersen approach. J Orthop Trauma. 2010;24(6):355-8. doi: 10.1097/BOT.0b013e3181c675d0. [PubMed: 20502217].
19. Paillard P. Hip replacement by a minimal anterior approach. Int Orthop. 2007;31(Suppl 1):S13-S15. doi: 10.1007/s00264-007-0433-7. [PubMed: 17657491]. [PubMed Central: PMC2267519].
20. Ropars M, Morandi X, Huten D, Thomazeau H, Berton E, Darnault P. Anatomical study of the lateral femoral cutaneous nerve with special reference to minimally invasive anterior approach for total hip replacement. Surg Radiol Anat. 2009;31(3):199-204. doi: 10.1007/s00276-008-0433-3. [PubMed: 18982237].
21. Ye Y, Chen K, Tian K, Li W, Mauffrey C, Hak DJ. Medial buttress plate augmentation of cannulated screw fixation in vertically unstable femoral neck fractures: Surgical technique and
preliminary results. Injury. 2017;48(10):2189-93. doi:
10.1016/j.injury.2017.08.017. [PubMed: 28818323].
22. Bertin KC, Rottinger H. Anterolateral mini-incision hip replacement surgery: a modified Watson-Jones approach. Clin Orthop Relat Res. 2004;(429):248-55. [PubMed: 15577495].
23. Kunapuli SC, Schramski MJ, Lee AS, Popovich JM, Cholewicki J, Reeves NP, et al. Biomechanical analysis of augmented plate fixation for the treatment of vertical shear femoral neck fractures. J Orthop Trauma. 2015;29(3):144-50. doi: 10.1097/BOT.0000000000000205. [PubMed: 25072287].
24. Su Z, Liang L, Hao Y. Medial femoral plate with cannulated screw for Pauwels type III femoral neck fracture: A meta-analysis. J Back Musculoskelet Rehabil. 2021;34(2):169-77. doi: 10.3233/BMR-200183. [PubMed: 33164925].
25. Medda S, Snoap T, Carroll EA. Treatment of young femoral neck fractures. J Orthop Trauma. 2019;33(Suppl 1):S1-S6. doi: 10.1097/BOT.0000000000001369. [PubMed: 30540665].
2. Najafi A, Tavakoli M, Zargar D, Hadavi D, Seif E, Azarsina S. Valgus impacted femoral neck fractures: Surgery or non-operative approach?. J Orthop Spine Trauma. 2021;7(2):39-43. doi: 10.18502/jost.v7i2.6998.
3. Siavashi B, Heshmati M, Golbakhsh MR, Shafiei SH, Mahdavi F, Sadeghi M, et al. A web-based dynamic nomogram to calculate the risk of nonhealing after femoral neck fracture fixation among young adults: Bench to bedside translational research.
J Orthop Spine Trauma. 2022;7(3):85-94. doi: 10.18502/jost.v7i3.8104.
4. Kurylo JC, Templeman D, Mirick GE. The perfect reduction: Approaches and techniques. Injury. 2015;46(3):441-4. doi: 10.1016/j.injury.2014.11.027. [PubMed: 25616674].
5. Slobogean GP, Sprague SA, Scott T, McKee M, Bhandari M. Management of young femoral neck fractures: Is there a
consensus? Injury. 2015;46(3):435-40. doi: 10.1016/j.injury.2014.11.028. [PubMed: 25530411].
6. Garden RS. Malreduction and avascular necrosis in subcapital fractures of the femur. J Bone Joint Surg Br. 1971;53(2):183-97. [PubMed: 5578215].
7. Reikeras O, Gunderson RB. Cross table lateral radiography for measurement of acetabular cup version. Ann Transl Med. 2016;4(9):169. doi: 10.21037/atm.2016.05.08. [PubMed: 27275482]. [PubMed Central: PMC4876262].
8. Lowell JD. Results and complications of femoral neck fractures. Clin Orthop Relat Res. 1980;(152):162-72. [PubMed: 7438599].
9. Ding DY, Mahure SA, Mollon B, Shamah SD, Zuckerman JD, Kwon YW. Comparison of general versus isolated regional anesthesia in total shoulder arthroplasty: A retrospective propensity-matched cohort analysis. J Orthop. 2017;14(4):417-24. doi:
10.1016/j.jor.2017.07.002. [PubMed: 28794581]. [PubMed Central: PMC5537444].
10. Florschutz AV, Langford JR, Haidukewych GJ, Koval KJ. Femoral neck fractures: current management. J Orthop Trauma. 2015;29(3):121-9. doi: 10.1097/BOT.0000000000000291. [PubMed: 25635363].
11. Rhorer AS. Percutaneous/minimally invasive techniques in treatment of femoral shaft fractures with an intramedullary nail. J Orthop Trauma. 2009;23(5 Suppl):S2-S5. doi: 10.1097/BOT.0b013e31819f2569. [PubMed: 19390371].
12. Chua D, Jaglal SB, Schatzker J. Predictors of early failure of fixation in the treatment of displaced subcapital hip fractures.
J Orthop Trauma. 1998;12(4):230-4. doi: 10.1097/00005131-199805000-00002. [PubMed: 9619456].
13. Duckworth AD, Bennet SJ, Aderinto J, Keating JF. Fixation of intracapsular fractures of the femoral neck in young patients: risk factors for failure. J Bone Joint Surg Br. 2011;93(6):811-6. doi: 10.1302/0301-620X.93B6.26432. [PubMed: 21586782].
14. Lichstein PM, Kleimeyer JP, Githens M, Vorhies JS, Gardner MJ, Bellino M, et al. Does the Watson-Jones or modified Smith-Petersen approach provide superior exposure for femoral neck fracture fixation? Clin Orthop Relat Res. 2018;476(7):1468-76. doi: 10.1097/01.blo.0000533627.07650.bb. [PubMed: 29698292].
[PubMed Central: PMC6437565].
15. Singh K, Weitlich JD, Zitsch BP, Schweser KM, Cook JL, Crist BD. Which surgical approach provides maximum visualization and access for open reduction and internal fixation (ORIF) of femoral neck fractures? Injury. 2022;53(3):1131-6. doi: 10.1016/j.injury.2021.11.023. [PubMed: 34809924].
16. Patterson JT, Ishii K, Tornetta P, Leighton RK, Friess DM, Jones CB, et al. Smith-Petersen versus Watson-Jones approach does not
affect quality of open reduction of femoral neck fracture. J
Orthop Trauma. 2021;35(10):517-22. doi:
10.1097/BOT.0000000000002068. [PubMed: 34510125].
17. Molnar RB, Routt ML. Open reduction of intracapsular hip fractures using a modified Smith-Petersen surgical exposure. J
Orthop Trauma. 2007;21(7):490-4. doi:
10.1097/BOT.0b013e31804a7f7f. [PubMed: 17762484].
18. Blair JA, Stinner DJ, Kirby JM, Gerlinger TL, Hsu JR. Quantification of femoral neck exposure through a minimally invasive Smith-Petersen approach. J Orthop Trauma. 2010;24(6):355-8. doi: 10.1097/BOT.0b013e3181c675d0. [PubMed: 20502217].
19. Paillard P. Hip replacement by a minimal anterior approach. Int Orthop. 2007;31(Suppl 1):S13-S15. doi: 10.1007/s00264-007-0433-7. [PubMed: 17657491]. [PubMed Central: PMC2267519].
20. Ropars M, Morandi X, Huten D, Thomazeau H, Berton E, Darnault P. Anatomical study of the lateral femoral cutaneous nerve with special reference to minimally invasive anterior approach for total hip replacement. Surg Radiol Anat. 2009;31(3):199-204. doi: 10.1007/s00276-008-0433-3. [PubMed: 18982237].
21. Ye Y, Chen K, Tian K, Li W, Mauffrey C, Hak DJ. Medial buttress plate augmentation of cannulated screw fixation in vertically unstable femoral neck fractures: Surgical technique and
preliminary results. Injury. 2017;48(10):2189-93. doi:
10.1016/j.injury.2017.08.017. [PubMed: 28818323].
22. Bertin KC, Rottinger H. Anterolateral mini-incision hip replacement surgery: a modified Watson-Jones approach. Clin Orthop Relat Res. 2004;(429):248-55. [PubMed: 15577495].
23. Kunapuli SC, Schramski MJ, Lee AS, Popovich JM, Cholewicki J, Reeves NP, et al. Biomechanical analysis of augmented plate fixation for the treatment of vertical shear femoral neck fractures. J Orthop Trauma. 2015;29(3):144-50. doi: 10.1097/BOT.0000000000000205. [PubMed: 25072287].
24. Su Z, Liang L, Hao Y. Medial femoral plate with cannulated screw for Pauwels type III femoral neck fracture: A meta-analysis. J Back Musculoskelet Rehabil. 2021;34(2):169-77. doi: 10.3233/BMR-200183. [PubMed: 33164925].
25. Medda S, Snoap T, Carroll EA. Treatment of young femoral neck fractures. J Orthop Trauma. 2019;33(Suppl 1):S1-S6. doi: 10.1097/BOT.0000000000001369. [PubMed: 30540665].
| Files | ||
| Issue | Vol 9, No 1 (2023) | |
| Section | Review Article | |
| DOI | https://doi.org/10.18502/jost.v9i1.12564 | |
| Keywords | ||
| Femoral Neck; Fractures Internal Fracture Fixation Open Reduction Surgical Procedures | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Apivatthakakul T. Surgical Approaches for Femoral Neck Fractures: A Review Article. J Orthop Spine Trauma. 2023;9(1):14-9.
