Smith-Petersen versus Watson-Jones approach does not affect quality of open reduction of femoral neck fracture.

Abstract

OBJECTIVE\nTo compare immediate quality of open reduction of femoral neck fractures by alternative surgical approaches.\n\n\nDESIGN\nRetrospective cohort study.\n\n\nSETTING\n12 Level 1 North American trauma centers.\n\n\nPATIENTS\n80 adults aged 18-65 years with isolated, displaced, OTA/AO type 31-B2 or -B3 femoral neck fractures treated with internal fixation.\n\n\nINTERVENTION\n32 modified Smith-Petersen anterior approaches versus 48 Watson-Jones anterolateral approaches for open reduction performed by fellowship-trained orthopaedic trauma surgeons.\n\n\nMAIN OUTCOME\nReduction quality as assessed by three senior orthopaedic traumatologists as acceptable or unacceptable on AP and lateral postoperative radiographs.\n\n\nRESULTS\nNo difference was observed in the rate of acceptable reduction by modified Smith-Petersen (81%) versus Watson-Jones (81%) approach (risk difference null, 95% confidence interval -17.4% to 17.4%, p = 1.00) with 90.4% panel agreement (Fleiss weighted κ = 0.63, p < 0.01). Stratified analyses did not identify a significant difference in the rate of acceptable reduction between approaches when stratified by Pauwels angle, basicervical or transcervical fracture location, or posterior comminution. The Smith-Petersen approach afforded a better reduction when preoperative skeletal traction was not applied (RR = 1.67 [95% CI 1.10-2.52] versus RR = 0.87 [95% CI 0.70-1.08], p = 0.006).\n\n\nCONCLUSIONS\nNo difference was observed in the quality of open reduction of displaced femoral neck fractures in young adults when a Watson-Jones anterolateral approach versus a modified Smith-Petersen anterior approach was performed by orthopaedic trauma surgeons.\n\n\nLEVEL OF EVIDENCE\nTherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.