Novel internal fixation technique for Pauwels type III neck of femur fractures using the femoral neck system in conjunction with a medial buttress plate - a case report

Sep 30, 2026

Background: Femoral neck fractures in patients under 50 years of age are rare, usually linked to high-energy trauma, and Pauwels type III fractures pose major biomechanical treatment challenges. Materials and Methods: A 37-year-old man with a sports injury underwent fixation using the Femoral Neck System combined with a medial buttress plate; postoperative X-rays and outcomes were tracked, and the technique was replicated in a second patient. Results: Both procedures were completed without complications, achieving union with no osteonecrosis or hardware failure over 1 year. Conclusion: The combined approach offers promising stability for high-angle fractures in young patients.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Abstract

1. Introduction

Femoral neck fracture epidemiology and challenges

Pauwels classification and biomechanical rationale

Fixation methods and knowledge gap

2. Statement of Informed Consent

3. Case Report

Case Report Novel internal fixation technique for Pauwels type III neck of femur fractures using the femoral neck system in conjunction with a medial buttress plate: a case report Devonny Sherwood, MBBSa * , Rajitha Gunaratne, MBBS, FRACS, PhDa,b,c Abstract Background: Femoral neck fractures in patients under 50 years of age are rare and primarily associated with high energy trauma. We documented the use of a novel internal fixation technique to manage a Pauwels type III fracture, which presents significant biomechanical challenges in treatment. Materials and Methods: A 37-year-old man sustained a Pauwels type III fracture after a sports injury. The combination of the Femoral Neck System in conjunction with a medial buttress plate was used to enhance fixation stability. Postoperative X-rays and outcomes are presented. This technique was replicated in a second patient with a similar fracture and outcomes monitored during routine follow-up. Results: Both procedures were performed without complication. Successful fracture union was achieved, with no evidence of osteonecrosis or hardware failure on follow-up over the course of 1 year. Conclusion: The combined approach ofthe Femoral Neck System with a medial buttress plate provides a promising solution to the biomechanical challenges associated with high-angle femoral neck fractures. This approach may offer enhanced fixation stability in young patients with high-energy trauma. Keywords: young NOF fracture, Pauwels type III, internal fixation, femoral neck system, medial buttress plate 1. Introduction Femoral neck fractures in patients under 50 years of age are relatively rare, comprising 2% to 3% of all neck of femur (NOF) fractures.1 Most of these injuries are associated with high-energy trauma, often related to motor vehicle accidents or sports injuries.2 Managing these fractures poses unique challenges due to anatomical and biomechanical complexities, especially in younger patients where preserving the natural hip joint and function is paramount. A significant concern in treating femoral neck fractures is the risk of complications such as avascular necrosis (AVN) and nonunion, The authors have no conflicts of interest to disclose. a Joondalup Health Campus, Joondalup, WA, Australia, b Curtin University Medical School, Bentley, WA, Australia, c Perth Orthopaedic Specialist Centre, St John of God Hospital Mt Lawley, Mt Lawley, Australia. *Corresponding author. Address: Perth Orthopaedic Specialist Centre, St John of God Hospital Mt Lawley, Ellesmere Rd, Mt Lawley 6050, Australia. E-mail address: [devonnysherwood@yahoo.com](devonnysherwood@yahoo.com) (D. Sherwood). Source of funding: Nil. This research has not been previously presented as a manuscript or abstract. Copyright © 2026 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Orthopaedic Trauma Association. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. OTAI (2026) e464 Received: 27 February 2025 / Accepted: 5 December 2025 Published online 7 January 2026 [http://dx.doi.org/10.1097/OI9.0000000000000464](http://dx.doi.org/10.1097/OI9.0000000000000464) especially due to the precarious blood supply to the femoral head. AVN can occur in 12% to 47% of NOF fractures after internal fixation, depending on fracture type, patient factors, and surgical technique.3 Nonunion rates can also be as high as 10% to 30% in displaced fractures.4 In younger patients, preserving joint integrity and achieving stable, anatomic reduction is crucial due to greater long-term functional demands. The performance of a bone–implant construct is known to depend on implant material, structural properties, and bone q

FAQs

What fracture type and patient profile does the case report focus on?

The report focuses on Pauwels type III femoral neck fractures in a young adult (a 37-year-old man) and replicates the technique in a second young male patient. Femoral neck fractures under age 50 are described as relatively rare.

How does the described fixation technique work?

It uses the Femoral Neck System combined with a medial buttress plate to enhance fixation stability. The approach is intended to address biomechanical challenges of high-angle fracture patterns.

What outcomes were reported after surgery?

Both procedures were performed without complication, with successful fracture union. Follow-up over one year showed no evidence of osteonecrosis or hardware failure.

Sep 30, 2026

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