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J Orthop Trauma. 2014 Apr 1. [Epub ahead of print]

Pre-operative Decision-Making in the Treatment of High-Angle "Vertical" Femoral Neck Fractures in Young Adult Patients.

Author information

  • 11Resident, Orthopedic Surgery, University of North Texas Health Science Center/John Peter Smith Hospital, Fort Worth, TX 2Orthopedic Traumatologist, Assistant Professor, San Antonio Military Medical Center (SAMMC), San Antonio, TX 3Director of Orthopedic Trauma, Harris Methodist Fort Worth Hospital, Staff physician John Peter Smith Orthopedic Surgery Residency, Fort Worth, TX.

Abstract

OBJECTIVE::

To identify the current implant and diagnostic imaging preferences among orthopedic trauma experts for the treatment of high-energy vertical femoral neck fractures in young adult patients.

DESIGN::

Web-based survey SETTING:: N/A PARTICIPANTS:: Active members of the Orthopaedic Trauma Association (OTA) METHODS:: A cross sectional expert opinion survey was administered to active members of the OTA to determine their preferences for implant use and imaging in the surgical treatment of a vertical femoral neck fracture in a young adult patient (e.g. 60° Pauwels' angle fracture in a healthy 30 year old patient). Questions were also asked regarding the reason this implant was selected, whether the surgeon felt their choice was supported by the literature, and what imaging studies are routinely obtained to guide decision-making. Data was collected using simple multiple-choice questions and/or a 5-point Likert item.

RESULTS::

Two-hundred and seventy-two surgeons (47%) responded to the survey. The preferred constructs for a vertical femoral neck fracture in a healthy young patient were a sliding hip screw with or without an anti-rotation screw (47%), parallel cannulated screws with an off-axis screw (28%), and parallel cannulated screw constructs (15%). When asked if their designated construct "was clearly supported by the literature," 46% were either unsure or disagreed. Seventy percent of surgeons chose their preferred implant because it was "biomechanically most stable." The majority of surgeons required AP pelvis (70%) and standard hip (88%) radiographs, however only 29% of surgeons required a CT scan (59% found CT helpful but not required). Twenty seven percent of surgeons have changed their implant choice intraoperatively.

CONCLUSIONS::

Femoral neck fractures in young adult patients are a challenging problem with high rates of failed treatment. Many options for treatment exist and a consensus on the best method remains elusive. Our survey demonstrates the diversity and disagreement among OTA member "expert" orthopedic traumatologists for the "best" treatment choice for this important clinical scenario. Our survey shows a divided level of confidence in the current literature and highlights the need for further study of this problem.

LEVEL OF EVIDENCE::

Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.

PMID:
24694558
[PubMed - as supplied by publisher]
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