31
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      An update on the Pauwels classification

      review-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          Femoral neck fractures typically occur as a result of high-energy mechanisms among non-geriatric patients. Complications, including femoral neck shortening, non-union, and avascular necrosis, are relatively common after the internal fixation of this fracture pattern. These complications have serious effects on young patients. The Pauwels classification, which is the first biomechanical classification for femoral neck fractures, is still frequently used to determine and prescribe the appropriate treatment for femoral neck fractures. However, we lack a unified standard for measuring the Pauwels angle, which may make the classification unreliable. Understanding the relationship between the Pauwels classification and the complications arising from the internal fixation of femoral neck fractures is necessary. Meanwhile, a Pauwels type III femoral neck fracture among young adults, which involves a high shear load at the fracture site, is difficult to treat successfully. In addition, the recognized internal fixation for this fracture pattern remains uncertain.

          Main body

          This review aims to provide an update on the viewpoint on the Pauwels classification including the measurement of the Pauwels angle and to present evidence to prove the aforementioned relationship. Moreover, this article also discusses the optimal internal fixation for femoral neck fractures based on the Pauwels classification.

          Conclusion

          A unified standard of measurement should be established for the Pauwels classification, which is still frequently used in the literature and in determining appropriate treatment for femoral neck fractures, to achieve a credible classification. In addition, more randomized, multicentric, and prospective trials should be conducted in the future to clearly understand the relationship between the Pauwels classification and complications arising from the internal fixation of femoral neck fractures and, consequently, to explore ideal fixations for a Pauwels type III femoral neck fracture.

          Related collections

          Most cited references50

          • Record: found
          • Abstract: found
          • Article: not found

          Femoral neck fractures: current management.

          Femoral neck fractures are a commonly encountered injury in orthopaedic practice and result in significant morbidity and mortality. It is essential that surgeons are able to recognize specific fracture patterns and patient characteristics that indicate the use of particular implants and methods to effectively manage these injuries. Use of the Garden and Pauwels classification systems has remained the practical mainstay of femoral neck fracture characterization that help dictate appropriate treatment. Operative options include in situ fixation, closed or open reduction and internal fixation, hemiarthroplasty, and total hip arthroplasty. Recent reports demonstrate diversity among orthopaedic surgeons in regard to the optimal treatment of femoral neck fractures and changing trends in management. The present discussion focuses on the current indications and methods for femoral neck fracture management to provide direction with respect to appropriate and effective care of these injuries.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Effect of femoral offset on range of motion and abductor muscle strength after total hip arthroplasty.

            At a minimum of one year after operation, we studied 64 patients with 86 total hip arthroplasties (THA) by standard anteroposterior hip and pelvic radiographs and measurement of range of motion and of isometric abduction strength. The femoral offset correlated positively with the range of abduction (p = 0.046). Abduction strength correlated positively with both femoral offset (p = 0.0001) and the length of the abductor lever arm (p = 0.005). Using multiple regression, abduction strength correlated with height (p = 0.017), gender (p = 0.0005), range of flexion (p = 0.047) and the abductor lever arm (p = 0.060). Our findings suggest that greater femoral offset after THA allows both an increased range of abduction and greater abductor strength.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years.

              There is a paucity of data on the treatment of femoral neck fractures in young patients. The purpose of the present study was to review the results and complications associated with the treatment of femoral neck fractures with internal fixation in a large consecutive series of young patients. Between 1975 and 2000, eighty-three femoral neck fractures in eighty-two consecutive patients who were between fifteen and fifty years old were treated with internal fixation at our institution. Two patients died, and eight were lost to follow-up. Seventy-three fractures were followed until union, until conversion to hip arthroplasty, or for a minimum of two years; the mean duration of follow-up was 6.6 years. Fifty-one of the seventy-three fractures were displaced, and twenty-two were nondisplaced. The results and complications of treatment were retrospectively reviewed, and the effects of fracture displacement, reduction quality, and capsular decompression on outcome were evaluated. Function was assessed by evaluating pain, walking capacity, and the need for gait aids. The mean duration of follow-up for the fifty-seven patients (fifty-eight fractures) who had not undergone early conversion to arthroplasty was 8.1 years. Fifty-three (73%) of the seventy-three fractures healed after one operation and were associated with no evidence of osteonecrosis of the femoral head. Osteonecrosis developed in association with seventeen fractures (23%), and a nonunion developed in association with six (8%). Four of the six nonunions later healed after a secondary procedure. At the time of the final follow-up, thirteen patients had had a conversion to a total hip arthroplasty because of osteonecrosis (eleven), nonunion (one), or both (one). Five (9.8%) of the fifty-one displaced fractures were associated with the development of nonunion, and fourteen (27%) were associated with the development of osteonecrosis. Three (14%) of the twenty-two nondisplaced fractures were associated with the development of osteonecrosis, and one (4.5%) was associated with the development of nonunion. Eleven (24%) of the forty-six displaced fractures with a good to excellent reduction were associated with the development of osteonecrosis, and two (4%) were associated with the development of nonunion. Four of the five displaced fractures with a fair or poor reduction were associated with the development of osteonecrosis, nonunion, or both. The ten-year survival rate of the native femoral head free of conversion to total hip arthroplasty was 85%. Osteonecrosis was the main reason for conversion to total hip arthroplasty, but not all patients with osteonecrosis required further surgery. The results of treatment were influenced by fracture displacement and the quality of reduction.
                Bookmark

                Author and article information

                Contributors
                shenmin_gk@163.com
                wangchen_gk@163.com
                chenhui@seu.edu.cn
                ruiyunfeng@126.com
                drzhaosong1980@163.com
                Journal
                J Orthop Surg Res
                J Orthop Surg Res
                Journal of Orthopaedic Surgery and Research
                BioMed Central (London )
                1749-799X
                12 December 2016
                12 December 2016
                2016
                : 11
                : 161
                Affiliations
                [1 ]School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009 China
                [2 ]Department of Orthopaedics, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Ding Jia Qiao, Nanjing, Jiangsu 210009 China
                [3 ]Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai, 200233 China
                Article
                498
                10.1186/s13018-016-0498-3
                5154085
                27955672
                9e2d5b9c-eafa-4dd8-92a5-6705a08f4bcc
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 27 September 2016
                : 7 December 2016
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Award ID: 81572188
                Award Recipient :
                Categories
                Review
                Custom metadata
                © The Author(s) 2016

                Surgery
                femoral neck fracture,pauwels classification,measurement of pauwels angle,post-operative complications,therapeutic guideline

                Comments

                Comment on this article

                scite_
                0
                0
                0
                0
                Smart Citations
                0
                0
                0
                0
                Citing PublicationsSupportingMentioningContrasting
                View Citations

                See how this article has been cited at scite.ai

                scite shows how a scientific paper has been cited by providing the context of the citation, a classification describing whether it supports, mentions, or contrasts the cited claim, and a label indicating in which section the citation was made.

                Similar content96

                Cited by41

                Most referenced authors440