What’s the Claim?
A large, muticenter, retrospective, comparative study found that supplementing cannulated screw or fixed-angle device fixation with a small medial buttress plate when treating femoral neck fractures in patients under the age of 55 was associated with a substantial reduction in the likelihood of failure (defined as loss of fixation, osteonecrosis, or shortening). Small-fragment plates (rather than mini-frag plates) and medial plate placement (instead of anteromedial) were better. The between-group difference was large — 29% of those with plate augmentation failed compared to 49% of those without a plate. Nearly 9 of 10 patients who had treatment failure received more surgery as a direct result.
How’s It Stack Up?
The original article describing buttress plating for these fractures stated: “Buttress plate fixation is a common method for stabilizing fractures that require resistance to shear forces and stands as one of the basic principles of fracture care.” That article is only eight years old; it’s rather amazing that we've been treating femoral neck fractures for so long without invoking that ancient principle. Several biomechanical studies support the concept, but relatively few clinical studies. All of those were observational (retrospective), and all were much smaller than this one, but all delivered the same main finding — little buttress plates make a big difference.