An update on the Pauwels classification
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REVIEW
Open Access
An update on the Pauwels classification Min Shen1, Chen Wang2*, Hui Chen2, Yun-feng Rui2 and Song Zhao3
Abstract Background: Femoral neck fractures typically occur as a result of high-energy mechanisms among non-geriatric patients. Complications, including femoral neck shortening, non-union, and avascular necrosis, are relatively common after the internal fixation of this fracture pattern. These complications have serious effects on young patients. The Pauwels classification, which is the first biomechanical classification for femoral neck fractures, is still frequently used to determine and prescribe the appropriate treatment for femoral neck fractures. However, we lack a unified standard for measuring the Pauwels angle, which may make the classification unreliable. Understanding the relationship between the Pauwels classification and the complications arising from the internal fixation of femoral neck fractures is necessary. Meanwhile, a Pauwels type III femoral neck fracture among young adults, which involves a high shear load at the fracture site, is difficult to treat successfully. In addition, the recognized internal fixation for this fracture pattern remains uncertain. Main body: This review aims to provide an update on the viewpoint on the Pauwels classification including the measurement of the Pauwels angle and to present evidence to prove the aforementioned relationship. Moreover, this article also discusses the optimal internal fixation for femoral neck fractures based on the Pauwels classification. Conclusion: A unified standard of measurement should be established for the Pauwels classification, which is still frequently used in the literature and in determining appropriate treatment for femoral neck fractures, to achieve a credible classification. In addition, more randomized, multicentric, and prospective trials should be conducted in the future to clearly understand the relationship between the Pauwels classification and complications arising from the internal fixation of femoral neck fractures and, consequently, to explore ideal fixations for a Pauwels type III femoral neck fracture. Keywords: Femoral neck fracture, Pauwels classification, Measurement of Pauwels angle, Post-operative complications, Therapeutic guideline
Background Femoral neck fractures typically occur in young patients as a result of high-energy trauma with a common pattern of a Pauwels type III fracture [1, 2]. Complications, including femoral neck shortening (FNS), non-union, and avascular necrosis (AVN), are relatively common after the internal fixation of this fracture pattern [3–9]. These complications will result in poor functional outcome and a high risk for reoperation and lifelong morbidity. The Pauwels classification, which is the first biomechanical classification for femoral neck fractures, is still frequently used at present [10, 11]. However, a series of misinterpretations and the lack of a unified standard for measuring the Pauwels angle may make the Pauwels classification * Correspondence: wa
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