Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Oct 1;35(10):517-522.
doi: 10.1097/BOT.0000000000002068.

Smith-Petersen Versus Watson-Jones Approach Does Not Affect Quality of Open Reduction of Femoral Neck Fracture

Joseph T Patterson  1 , Keisuke Ishii  2 , Paul Tornetta 3rd  3 , Ross K Leighton  4 , Darin M Friess  5 , Clifford B Jones  6 , Ari Levine  7 , Jeffrey J Maclean  2 , Theodore Miclau 3rd  2 , Brian H Mullis  8 , William T Obremskey  9 , Robert F Ostrum  10 , J Spence Reid  11 , John A Ruder  12 , Anas Saleh  7 , Andrew H Schmidt  13 , David C Teague  14 , Antonios Tsismenakis  3 , Jerald R Westberg  13 , Saam Morshed  2
Affiliations

Smith-Petersen Versus Watson-Jones Approach Does Not Affect Quality of Open Reduction of Femoral Neck Fracture

Joseph T Patterson et al. J Orthop Trauma. .

Abstract

Objective: To compare immediate quality of open reduction of femoral neck fractures by alternative surgical approaches.

Design: Retrospective cohort study.

Setting: Twelve Level 1 North American trauma centers.

Patients: Eighty adults 18-65 years of age with isolated, displaced, OTA/AO type 31-B2 or -B3 femoral neck fractures treated with internal fixation.

Intervention: Thirty-two modified Smith-Petersen anterior approaches versus 48 Watson-Jones anterolateral approaches for open reduction performed by fellowship-trained orthopaedic trauma surgeons.

Main outcome: Reduction quality as assessed by 3 senior orthopaedic traumatologists as "acceptable" or "unacceptable" on AP and lateral postoperative radiographs.

Results: No 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] vs. RR = 0.87 [95% CI 0.70-1.08], P = 0.006).

Conclusions: No 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.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

PubMed Disclaimer

Conflict of interest statement

All ICMJE Conflict of Interest Forms for authors and are on file with the publication and can be viewed on request: Joseph T. Patterson: AOTrauma North America: research support. Keisuke Ishii: Naradewa: research support. C. B. Jones: Arizona Orthopaedic Society: board or committee member, Dignity Health: employee, Journal of Bone and Joint Surgery—American: Editorial or governing board, Journal of Orthopaedics and Traumatology: Editorial or governing board, Lippincott: IP royalties, Orthopaedic Trauma Association OTA—grant: Research support, OsteConcentric: Paid consultant, IP royalties, Stryker: Paid consultant; Paid presenter or speaker. R. K. Leighton: AAOS: Board or committee member, Canadian Orthopaedic Association: board or committee member, DePuy, A Johnson & Johnson Company: Other financial or material support; paid presenter or speaker, Etex: paid consultant, Smith & Nephew: other financial or material support; paid presenter or speaker, Stryker: other financial or material support; paid presenter or speaker, Synthes: paid presenter or speaker; research support, Zimmer: paid presenter or speaker. T. Miclau: AO Foundation: board or committee member, Arquos: paid consultant; stock or stock Options, Baxter: research support, Bone Therapeutics: paid consultant, Globus Medical: other financial or material support, Inman Abbott Society: board or committee member, International Combined Orthopaedic Research Societies: board or committee member, International Orthopaedic Trauma Association: board or committee member, KCI: other financial or material support, NXTSENS: paid consultant, Orthopaedic Research Society: board or committee member, Orthopaedic Trauma Association: board or committee member, Osteosynthesis and Trauma Care Foundation: board or committee member, San Francisco General Hospital Foundation: board or committee member, Stryker: other financial or material support, Surrozen: paid consultant, Synthes: paid consultant. B. H. Mullis: Indiana Orthopaedic Society: board or committee member, KCI: paid consultant, Orthopaedic Trauma Association: Board or committee member. W. T. Obremskey: Journal of Bone and Joint Surgery - American: editorial or governing board, Journal of Orthopaedic Trauma: editorial or governing board, Journal of the American Academy of Orthopaedic Surgeons: editorial or governing board, Orthopaedic Trauma Association: board or committee member, Southeastern Fracture Consortium: board or committee member. R. F. Ostrum: Bioventus: paid consultant; paid presenter or speaker, Journal of Orthopaedics and Traumatology: editorial or governing board, SLACK Incorporated: publishing royalties, financial, or material support, Wolters Kluwer Health—Lippincott Williams & Wilkins: Editorial or governing board; publishing royalties, financial, or material support. J. S. Reid: Clinical Orthopaedics and Related Research: editorial or governing board, Journal of Orthopaedics and Traumatology: editorial or governing board, Limb Lengthening and Reconstruction Society: board or committee member, ROM3 now ROMtech: Stock or stock Options, Smith & Nephew: paid consultant, Synthes: paid consultant; research support, Zimmer: research support. Andrew H. Schmidt: ActivOrtho: stock or stock options, Conventus Orthopaedics: stock or stock options, Conventus Orthopedics: paid consultant, Enova Illumination, Inc.: stock or stock options, Epien: stock or stock options, Epix VAN: stock or stock options, JBJS Essential Surgical Techniques: editorial or governing board, Journal of Knee Surgery: editorial or governing board, Journal of Orthopaedic Trauma: editorial or governing board, Abbott Medical: paid consultant (spouse), Thieme, Inc.: publishing royalties, financial or material support, Twin Star Medical: stock or stock options. David C. Teague: Journal of Orthopaedic Trauma: Editorial or governing board, Orthopaedic Trauma Association: board or committee member. P. Tornetta III: Journal of Orthopaedic Trauma: editorial or governing board, Smith & Nephew: IP royalties Wolters Kluwer Health—Lippincott Williams & Wilkins: publishing royalties, financial or material support. S. Morshed: Orthopaedic Trauma Association: board or committee member. The remaining authors report no conflict of interest.

References

    1. Garden R. Stability and union in subcapital fractures of the femur. J Bone Joint Surg. Br. 1964;46:630–647.
    1. Garden R. Malreduction and avascular necrosis in subcapital fractures of the femur. J Bone Joint Surg. Br. 1971;53:183–197.
    1. Chua D, Jaglal SB, Schatzker J. Predictors of early failure of fixation in the treatment of displaced subcapital hip fractures. J Orthop Trauma. 1998;12:230–234.
    1. Ghayoumi P, Kandemir U, Morshed S. Evidence based update: open versus closed reduction. Injury. 2015;46:467–473.
    1. Haidukewych GJ, Rothwell WS, Jacofsky DJ, et al. Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years. J Bone Joint Surg. Am. 2004;86-A:1711–1716.