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Osteonecrosis of the femoral head nonunion and potential risk factors in Pauwels grade-3 femoral neck fractures

机译：Pauwels 3级股骨颈骨折的股骨头坏死骨不连及潜在危险因素

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The present study was to analyze clinical outcome of Pauwels grade-3 femoral neck fractures treated by different surgical techniques. Potential risk factors associated with nonunion and osteonecrosis of the femoral head (ONFH) were investigated as well. The retrospective study comprised of 67 sequential patients treated between January 2008 and December 2011. Patients with Pauwels grade-3 femoral neck fractures were treated by operative reduction and internal fixation. Cannulated screws (CS) were used in 46 patients, dynamic hip screw plus CS (DHS+CS) in 14, and locking compression plate (LCP) for proximal femur in 7. Reduction quality was assessed according to Haidukewych criteria. Postoperative radiographic examinations were conducted to observe fracture healing. Fracture displacement, comminution, fashion of internal fixation, and the sliding effect were analyzed, regarding the incidence of nonunion and ONFH. All patients had a follow-up of 21.6 ± 6.0 months on average. The phenomenon of sliding effect was observed in 16 cases (23.9%). In terms of reduction quality, 64 cases were graded as excellent, 2 were good, and 1 was poor. ONFH was presented in 15 cases (22.4%) and nonunion was found in 8 (11.9%), with 1 patient had ONFH and nonunion concomitantly. Profound hip contour was preserved in 45 cases (67.2%). The fashion of internal fixation yielded different results regarding ONFH and nonunion, whereas the effects of fracture displacement, comminution, and the sliding effect were not significant. ONFH and nonunion were common complications following Pauwels grade-3 femoral neck fractures. Higher incidence of ONFH in DHS+CS and of nonunion in the LCP group should be noted.
机译：本研究旨在分析不同手术方法治疗的Pauwels股骨颈3级骨折的临床结果。还研究了与股骨头骨不连和骨坏死（ONFH）相关的潜在危险因素。这项回顾性研究由2008年1月至2011年12月期间接受治疗的67例连续患者组成。Pauwels3级股骨颈骨折患者通过手术复位和内固定治疗。空心螺钉（CS）用于46例患者，动态髋螺钉加CS（DHS + CS）用于14例患者，股骨近端使用锁定加压钢板（LCP）在7例患者中。根据Haidukewych标准评估复位质量。术后进行射线照相检查以观察骨折愈合情况。关于骨折不愈合和ONFH的发生率，分析了骨折移位，粉碎，内固定方式和滑动效果。所有患者平均随访21.6±±6.0个月。 16例（23.9％）出现滑动现象。就减少质量而言，优64例，良2例，差1例。 15例中有ONFH（22.4％），8例中有骨不连（11.9％），其中1例同时有ONFH和骨不连。 45例保留了髋部轮廓（67.2％）。内固定的方式在ONFH和骨不连方面产生了不同的结果，而骨折移位，粉碎和滑动效应的影响不明显。 Pauwels 3级股骨颈骨折后，ONFH和骨不连是常见的并发症。应注意DHS + CS中ONFH的发生率较高，而LCP组中的不愈合率较高。

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