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Misinterpretation of Pauwel’s Classification

 

Z Ahmad, Academic Clinical Fellow, L Lutchman, Consultant Orthopaedic Surgeon, J Nolan, Consultant Orthopaedic Surgeon, P Hopgood, Consultant Orthopaedic Surgeon
Department of Orthopaedics, Norfolk and Norwich Hospital NHS Trust, Colney Lane, Norwich NR4 7UY, UK

Correspondence should be sent to: Zafar.ahmad@doctors.org.uk

Pauwel’s classification was first published in 1935 in German, and was the first biomechanical classification of neck of femur fractures.1 Although its use has declined, it is still mentioned in a number of articles and books. We have found a discrepancy in the interpretation of type 3 of Pauwel’s femoral neck fracture classification. Some sources quote type 3 as beginning at 70 degrees2 while others quote it at 50 degrees.3

Bartonicek published a paper 20014 that stated that the correct interpretation for a type 3 fracture is from an angle of 50 degrees.  Bartonicek explains that the misunderstanding of the original text is likely to be authors quoting a secondary source that misinterpreted the original German text, or more likely those who had the original, but based their interpretation only on the figures, and did not study the text of the book which was in German. We have also looked at the original translation of Pauwel’s book by Furlong1 in 1976 from the British Library that confirms Bartonieck findings.  We undertook a search of the following books/websites which despite this paper continue to quote the incorrect figures (See Table 1).

Despite its limitation, Pauwel’s classification is still in use. Therefore for the sake of assessing its validity or for the purpose of those involved in exams or are examiners in Orthopaedics, one must be aware of this discrepancy.

Table 1: Selection of books/websites viewed with the incorrect classification

Author/Editor

Title/Website

Edition

Year

Page/Address

Reference given

Koval et al

Handbook of fractures

4th

2010

p. 381

No, to Rockwood and Green 4th edition. 1996.

Miller

Review of Orthopaedics

6th

2012

Figure 11.42

Not to original text

Kulkarni

Textbook of Orthopaedics and Trauma

2nd

2009

P. 2030

Yes, not to original text

Siddiqui et al

Adult Limb Fractures

1st

2001

p.20

Yes to original text.

Mostofi

Fracture classifications in clinical practice

1st

2006

p.44

Nil

Banaskiewicz et al

Postgraduate Orthopaedics

1st

2009

p.439

Yes to original text

Bucholz

Rockwood and Green Fractures in the Adult

6th

2006

Figure 44.4. Has been updated to correct classification in 10th edition.

Yes to original text.

Benoudina

Orthopaedics One

 

2012

http://www.orthopaedicsone.com/display/Main/Femoral+neck+fractures+-+Pauwels+classification

Nil

 

E-Radiography

 

2013

http://www.e-radiography.net/radpath/f/femur%20fracture/neck_of_femur.htm

Yes, not to original text

 

References

1. Pauwels F, Furlong RJ, Maquet P. Biomechanics of the normal and diseased hip, theoretical foundation, technique and results of treatment an atlas. Germany: Springer Verlag 1976.
2. Koval KJ, Zuckerman ZD. Handbook of fractures. Third ed. 2006, Philadelphia: Lippincott Williams & Wilkins. xiii, 685 p.
3. Ly TV, Swiontkowski MF. Treatment of femoral neck fractures in young adults. J Bone Joint Surg [Am] 2008;90-A:2254-66.
4. Bartonicek J. Pauwels' classification of femoral neck fractures: correct interpretation of the original. J Orthop Trauma 2001;15:358-60.