• Kaiyang Wang, Ming Ni, Peng Liao, Bang Dou, Xu Yan, Lin Lv, Fangfang Zhang, and Jiong Mei.
• Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, NO. 600, Yishan Rd., Shanghai, 200233, P.R.China. Electronic address: ortho_wang@163.com.
• Injury. 2021 Nov 1; 52 (11): 3227-3238.

BackgroundPauwels classification, which categorizes types of femoral neck fractures, cannot fully reflect the three-dimensional characteristics of this injury. The purpose of our study was to determine the morphological characteristics of Pauwels III fractures through computed tomography image analysis and summarize the relevant biomechanical characteristics of different morphological fractures.MethodsWe retrospectively reviewed a total of 209 patients diagnosed with Pauwels type III femoral neck fractures. Fracture reduction was simulated based on mirror symmetry of the bilateral femur by Mimics. The fracture angle was measured and subtypes were defined. Biomechanical characteristics were compared by finite element analysis and validated using a biomechanical experiment, which was performed on a cadaveric sample.ResultsPauwels III femoral neck fractures can be divided into three subtypes: anterior, posterior, and classical. The proportion of three subtypes was 28.71%, 67.46%, and 3.82%, respectively. The anterior subtype showed the lowest axial stiffness but highest implant and bone stress. High stress distributions was concentrated on the screw-bone interface and screw-plate connections.ConclusionsBiomechanical differences across the three subtypes of Pauwels III femoral neck fractures could increase our understanding of the biomechanical characteristics that underlie the Pauwels type III femoral neck fractures (such as, three-dimensional morphology and the stress distribution of bone and implant) that have been associated with high failure rates.Copyright © 2021. Published by Elsevier Ltd.

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