Get high-quality reduction to treat ‘young’ femoral neck fractures
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Key takeaways:
- Technical errors will have additive effects that can result in failures.
- If using a fixed-angle device, like a sliding hip screw, it is important to get a good, deep, tip apex distance.
KOLOA, Hawaii — Orthopedic surgeons need to know the medial pathoanatomy of the femoral neck and obtain a high-quality reduction in the treatment of “young” femoral neck fractures, according to a presenter at Orthopedics Today Hawaii.
Collinge defined young fractures as those occurring in adults younger than 50 years.
“What that does is, it changes the mechanics back to more normal, provides some immediate stability, if you’re lucky, and provides great bone-to-bone contact for healing,” Cory A. Collinge, MD, said at Orthopedics Today Hawaii.
Collinge also said to use a fixed-angled device and meet technical benchmarks.
“We know what the technical benchmarks are – a good reduction. If you use a fixed-angle device, like a sliding hip screw, get a good, deep, tip apex distance. If you decide to use multiple cannulated screws, put one along the calcar as best you can, if you can, and then put it deep and put it centrally and spread them out,” Collinge said.
He said technical errors are common and outcome studies indicate the errors will have additive effects that can result in failures. Collinge also said to consider medial buttress plating.
“If you’re going to do an open reduction, consider putting a plate on the medial side. If you haven’t done that before, there’s plenty out there about how to do it. One of the key elements of it though is it has to be a medial plate. It’s not a buttress plate if it isn’t over the apex of the fracture. Anteriorly applied plates didn’t do particularly well.”
He said outcome studies indicate that if the buttress plate is placed medially, the failure rate is 4%.
“I would consider that heavily, especially if you do an open reduction,” Collinge said.
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Collinge CA. Young femoral neck fractures: 5 tips in 5 minutes. Presented at: Orthopedics Today Hawaii; Jan. 12-16, 2025; Koloa, Hawaii.
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