Closed reduction of Pauwels type Ⅲ femoral neck fractures using the abduction-external rota-tion method

Sun Guohai; Zhang Wupeng; Yang Yongliang; Pang Hongqian; Wang Bomin

doi:10.3969/j.issn.1009-4237.2025.04.004

Abstract：Objective To explore a novel reduction method for irreducible Pauwels type Ⅲ femoral neck fractures,aiming to provide an effective treatment approach and reduce the necessity of open reduction.Methods A retrospective analysis was conducted on 20 cases with irreducible Pauwels type Ⅲ femoral neck fractures admitted to our department from Dec.2021 to Dec.2023.This cohort consisted of 16 male and 4 female patients,aged 28-61 years,with an average of 43.1 years.All fractures were unilateral,with 12 on the left side and 8 on the right.The injury mechanisms included 6 cases of road traffic accidents,2 falls from height,and 12 accidental falls.When satis-factory reduction failed to be achieved with conventional adduction and internal rotation traction,the abduction-exter-nal rotation method was used for reduction.After then,all fractures were fixed with three cannulated screws or the femoral neck system(FNS)under intraoperative fluoroscopy.The intraoperative parameters and outcomes were re-corded.Results Using the abduction-external rotation reduction method,anatomical reduction was achieved for all the 20 cases.The average surgical time was 59.5 min,range 45-70 min;intraoperative blood loss was 24.5 mL,range 10-50 mL;the hospital stay was 5.3 d,range 3-7 d.Patients were followed up for 10-19 months,13.2 months on average.All incisions healed well without infection,and there were no complications such as fracture displace-ment,broken screws,or postoperative deep vein thrombosis.Conclusion The abduction-external rotation reduction method for Pauwels type Ⅲ femoral neck fractures has a high success rate,which significantly avoids the risk of open reduction,shortens the operation time,and is an effective treatment option for those hard-to-be-reduced by conven-tional ways.