Opinion Review
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Nov 18, 2021; 12(11): 811-815
Published online Nov 18, 2021. doi: 10.5312/wjo.v12.i11.811
Revisiting Pauwels' classification of femoral neck fractures
Sumon Nandi
Sumon Nandi, Orthopaedic Surgery Department, University of Maryland School of Medicine, Baltimore, MD 21201, United States
Author contributions: Nandi S reviewed the existing literature, performed the data analysis, and wrote the manuscript; He has approved the final manuscript
Conflict-of-interest statement: Nandi S has no conflicts of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sumon Nandi, MD, Associate Professor, Orthopaedic Surgery Department, University of Maryland School of Medicine, 110 S. Paca Street Ste 300, Baltimore, MD 21201, United States. sumon.nandi@gmail.com
Received: June 28, 2021
Peer-review started: June 28, 2021
First decision: July 27, 2021
Revised: July 31, 2021
Accepted: September 15, 2021
Article in press: September 15, 2021
Published online: November 18, 2021
Processing time: 140 Days and 22.5 Hours
Abstract

Pauwels’ femoral neck fracture classification is based on the biomechanical principle that shear stress and varus force increase along more vertically oriented fractures, resulting in higher risk of fracture displacement and ultimately nonunion. This principle continues to guide construct selection for femoral neck fracture internal fixation and is the foundation for treating non-union with valgus osteotomy. However, with poor inter- and intra-rater reliability, dated treatment recommendations, and unreliable prognostic value, the Pauwels classification cannot be directly applied in its entirety to the management of femoral neck fractures in modern practice.

Keywords: Pauwels; Fracture; Femoral neck; Internal fixation; Arthroplasty

Core Tip: Pauwels' classification of femoral neck fractures continues to guide construct selection for femoral neck fracture internal fixation and is the foundation for treating non-union with valgus osteotomy. However, with poor inter- and intra-rater reliability, dated treatment recommendations, and unreliable prognostic value, the Pauwels classification cannot be directly applied in its entirety to the management of femoral neck fractures in modern practice.