Abordaje de Smith Petersen modificado para fracturas de cuello femoral Pauwels III – Garden IV

Resumen

El abordaje de Smith Petersen modificado (SPM), permite la reducción de fracturas del cuello femoral desde anterior, manteniendo la fijación a través de un abordaje lateral. Realizar la reducción bajo visión directa mejoraría la calidad de la reducción y los resultados en fracturas complejas de cuello femoral.

Métodos Estudio retrospectivo de ocho pacientes con fracturas de cuello femoral Pauwels III/Garden IV secundarias a un accidente de alta energía operadas con abordaje SPM. Registramos el tiempo de evolución desde el accidente hasta la cirugía. Se realizó radiografía y tomografía axial computada postoperatoria. Seguimos los pacientes con radiografías mensuales hasta evidenciar consolidación de la fractura y casos de necrosis avascular.

Resultados En promedio, los pacientes fueron operados 2,1 días tras el accidente y fueron seguidos con una mediana de 24,5 meses tras su cirugía. Siete de los ocho pacientes consolidaron. Sólo un caso presentó una no-unión que requirió de una prótesis total de cadera. No hubo casos de necrosis avascular.

Conclusión Las fracturas de cuello femoral de alta energía en pacientes jóvenes son lesiones poco frecuentes. Aunque esta serie es pequeña, llama la atención que tratándose de lesiones desplazadas y con rasgos verticales no observamos casos de necrosis avascular, a pesar de algunos casos con prolongado tiempo de evolución desde el accidente hasta la cirugía. Creemos que esas fracturas deben operarse lo antes posible, pero que es más importante lograr una reducción anatómica en vez de retrasar algunas horas la cirugía. En nuestra experiencia, el abordaje de SPM facilita la reducción adecuada en fracturas complejas de cuello femoral.

Abstract

Modified Smith Petersen Approach (MSP) allows an anterior reduction for femoral neck fractures, keeping the fixation through a lateral approach to the hip. Performing the reduction under direct visualization would improve the quality of the reduction and the outcomes in complex fractures of femoral neck

Methods Retrospective study including eight patients with femoral neck fracture classified as Pauwels III / Garden IV, in which MSP was performed. We kept record of the time from the accident until the final surgery. Post-operative studies included plain radiograph and CT scan. Monthly radiographic controls were obtained until fracture healing was achieved or radiological signs of avascular necrosis were found.

Results Surgery was performed in an average of 2.1 days after the accident. Post-operative follow-up was an average of 24.5 month. Consolidation was achieved in seven of the eight patients, only one patient evolved into a nonunion of femoral neck which required a total hip arthroplasty.

Conclusion High energy femoral neck fractures in young patients are infrequent injuries. Even though this is a small series of patients it comes to our attention that being displaced fractures with vertical fracture lines we didn't find any case of avascular necrosis despite some of the cases the prolonged timing since the accident to surgery. We believe that this type of fracture should be treated as soon as possible but is more important to achieve an anatomical reduction than pass over the 12 hours threshold. In our experience MSP approach facilitates the achievement of an adequate reduction and complex femoral neck fractures

Palabras Clave

fractura de cadera - alta energía - Pauwels III - Garden IV

Keywords

hip fracture - high energy - Pauwels III - Garden IV

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