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15 Mar 2021
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Valgus impacted Pauwels 3 Garden I subcapital femur fracture

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Clinical Details

Clinical and radiological findings:  This case represents a relatively fit 67-year-old male who sustained a right sided non-displaced but valgus-impacted sub capital femur fracture (Garden I, Pauwels 3) following a bicycle accident. The fracture was able to be reduced almost completely on the traction table with minimal manipulation. A small lateral incision and trans-vastus approach to the femoral cortex was used. After securing the reposition of the fracture with 3 Kirshner wires I performed an anterior capsulotomy to facilitate decompression of any joint capsule haematoma. Subsequently three 7.3mm cannulated titanium screws with reverse cutting tips were used to fixate the fracture.

Preoperative Plan

Planning remarks: 

Surgical Discussion

Operative remarks: 

A relatively straightforward and technically non-challenging case. Of interest is perhaps the relative size and diameter of the femoral head in comparison to the femoral shaft in this largely built male. Radiologically it is always satisfying to see three parallel screws filling a good proportion of the femoral neck and head. In this case due to the relative size discrepancy of head and shaft the screws look a little anorexic, however considering the placement of the screws - in particular the most distal calcar screw - i think this construct represents a more than adequate fixational of an otherwise relatively unstable fracture pattern.

Orthopaedic implants used:   DePuy Synthes 7.3mm cannulated titanium screws with reverse cutting flute

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Dr Ed Oates
  • Germany , Schleswig Holstein
  • Area of Specialty - General Trauma
  • Position - Specialist Consultant
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