Med- to long-term clinical outcomes of modified Smith-Petersen approach in treatment of irreducible femoral neck fracture in young adults
10.3760/cma.j.cn115530-20210607-00267
- VernacularTitle:改良Smith-Petersen入路治疗中青年难复性股骨颈骨折的中长期随访结果分析
- Author:
Gang LIU
1
;
Ying LI
;
Yong WU
;
Yujiang MAO
;
Xinbao WU
Author Information
1. 北京积水潭医院创伤骨科 100035
- Keywords:
Femoral neck fractures;
Fracture fixation, internal;
Surgical approach;
Open reduction
- From:
Chinese Journal of Orthopaedic Trauma
2021;23(12):1057-1062
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the med- to long-term clinical outcomes of open reduction and cannulated screw fixation via the modified Smith-Petersen approach for irreducible femoral neck fractures in young adults.Methods:The clinical data of 16 young adults were retrospectively studied who had been treated for irreducible femoral neck fractures by open reduction and cannulated screw fixation via the modified Smith-Petersen approach by the same surgeon from December 2009 to February 2015 at Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital. There were 11 males and 5 females aged from 19 to 59 years (average, 42.9 years). All their fractures were closed Garden type Ⅳ, with high energy injury in 8 cases and low energy injury in the other 8 ones. The time from injury to surgery averaged 5.4 d (from 1 to 11 d). In all the patients, open reduction and cannulated screw fixation via the modified Smith-Petersen approach was conducted after ideal reduction had not been achieved by 3 continuous attempts in primary closed reduction in a traction bed. Recorded were the postoperative full weight-bearing time, return to work time, fracture union time, function of the affected hip and complications at the last follow-up in the patients.Results:The 16 patients were followed up for 6 to 12 years (average, 8.8 years). The postoperative full weight-bearing time averaged 12.7 weeks (from 2 to 16 weeks) in 16 patients; the return to work time averaged 15.0 weeks (from 3 to 20 weeks) and the fracture union time 3.5 months (from 3 to 6 months) in 15 patients while fracture nonunion happened in the other one. The HSS hip scores at the last follow-up averaged 90.3 points (from 62 to 98 points), yielding 12 excellent, 2 good, one fair and one poor cases. The one case with fracture nonunion underwent total hip arthroplasty (THA); of the 4 cases with avascular necrosis of the femoral head, 2 underwent THA; limited range of hip motion due to heterotopic ossification was noted in one case.Conclusion:Open reduction and cannulated screw fixation via the modified Smith-Petersen approach may lead to fine med- to long-term clinical outcomes in young adults whose femoral neck fracture cannot be reduced by closed reduction, because the modified Smith-Petersen approach allows fracture reduction under direct vision.
