HSS Journal ®

, Volume 9, Issue 2, pp 113–117 | Cite as

Incidence of Radiographic Cam-Type Impingement in Young Patients (<50) After Femoral Neck Fracture Treated with Reduction and Internal Fixation

  • Matthew C. Wendt
  • Joseph R. Cass
  • Robert R. Trousdale
Original Article



Cam-type femoral impingement is caused by structural abnormalities of the hip and is recognized as a cause of degenerative hip arthritis. Identifiable etiologies of this structural abnormality include congenital malformation, pediatric hip disease, and malunion of femoral neck fractures after internal fixation.


The purpose of this study was to determine the prevalence of radiographic impingement in healed Orthopaedic Trauma Association (OTA) type 31B fractures treated with reduction and internal fixation.


Seventy OTA 31B hip fractures treated with internal fixation were identified from our institutional trauma database and radiographs were retrospectively reviewed for signs of impingement. Mean follow-up was 53 months after fracture. Alpha angle, Mose templates, and femoral head retroversion were the measurements used to determine impingement.


The overall prevalence of any sign of radiographic impingement was 75%. Alpha angle was elevated in 32 hips (46%), asphericity was present in 46 femoral heads (65%), and femoral head retroversion was present in 26 hips (37%). The rates were highest in displaced subcapital fractures (OTA 31B-3) with a 63% (13/19) prevalence of elevated alpha angle, 68% (14/19) prevalence of asphericity, and 47% (10/19) prevalence of retroversion.


Prevalence of radiographic signs of impingement in this population is higher than expected based on population-based controls. Surgeons must be vigilant about reduction and fixation of femoral neck fractures. Malunion should be recognized as early intervention may be beneficial in improving long-term outcomes.


femoroacetabular impingement femoral neck fracture alpha angle cam lesion 


  1. 1.
    Allen D, Beaulé PE, Ramadan O, Doucette S. Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement. J Bone Joint Surg Br. 2009;91:589–94.PubMedGoogle Scholar
  2. 2.
    Beaulé PE, LeDuff MJ, Zaragoza EJ. Quality of life following femoral head/neck osteochondroplasty for femoroacetabular impingement. J Bone Joint Surg Am. 2007;89A:773–9.CrossRefGoogle Scholar
  3. 3.
    Beaulé PE, Zaragoza EJ, Motamedic K, Copelan N, Dorey J. Three-dimensionalcomputed tomography of the hip in the assessment of femoro-acetabular impingement. J Orthop Res. 2005;23:1286–92.PubMedGoogle Scholar
  4. 4.
    Beck M, Kalhor M, Leunig M, Ganz R. Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br. 2005;87:1012–8.PubMedGoogle Scholar
  5. 5.
    Beck M, Leunig M, Parvizi J, Boutier V, Wyss D, Ganz R. Anterior femoroacetabular impingement. Part II: midterm results of surgical treatment. Clin Orthop. 2004;418:67–73.PubMedCrossRefGoogle Scholar
  6. 6.
    Clohisy JC, Carlisle JC, Beaulé PE, Kim YJ, Trousdale RT, Sierra RJ, Leunig M, Schoenecker PL, Millis MB. A systematic approach to the plain radiographic evaluation of the young adult hip. J Bone Joint Surg Am. 2008;90:47–66.PubMedCrossRefGoogle Scholar
  7. 7.
    Dobbs MB, Weinstein SL. Natural history and long-term outcomes of slipped capital femoral epiphysis. Intr Course Lect. 2001;50:571–5.Google Scholar
  8. 8.
    Eijer H, Myers SR, Ganz R. Anterior femoroacetabular impingement after femoral neck fractures. J Orthop Trauma. 2001;15:475–81.PubMedCrossRefGoogle Scholar
  9. 9.
    Ganz R, Parvizi J, Beck M, Leunig M, Nötzli HP, Siebenrock KA. Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res. 2003;417:112–20.PubMedGoogle Scholar
  10. 10.
    Goodman DA, Feighan JE, Smith AD, et al. Subclinical slipped capital femoral epiphysis: relationship to osteoarthritis of the hip. J Bone Joint Surg [Am]. 1997;79-A:1489–97.Google Scholar
  11. 11.
    Gosvig KK, Jacogsen S, Sonne-Holm S, Gebuhr P. The prevalence of cam-type deformity of the hip joint: a survey of 4151 subjects of the Copenhagen Osteoarthritis Study. Acta Radiol. 2008;49:436–41.PubMedCrossRefGoogle Scholar
  12. 12.
    Hack K, Di Primio G, Rakhra K, Beaulé PE. Prevalence of cam-type femoroacetabular impingement morphology in asymptomatic volunteers. J Bone Joint Surg. Am. 2010;92:2436–44.PubMedCrossRefGoogle Scholar
  13. 13.
    Haidukewych GJ, Rothwell WS, Jacofsky DJ, Torchia ME, Berry DJ.G Operative treatment of femoral neck fractures in patients between the ages of fifteen and fifty years. J Bone Joint Surg Am. 2004;86:1711–6.PubMedGoogle Scholar
  14. 14.
    Ito K, Minka MA 2nd, Leunig S, Werlen S, Ganz R. Femoroacetabular impingement and the cam-effect. A MRI-based quantitative anatomical study of the femoral head-neck offset. J Bone Joint Surg Br. 2001;83:171–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Leunig M, Casillas MM, Hamlet M, Hersche O, Nötzli H, Slongo T, Ganz R. Slipped capital femoral epiphysis: early mechanical damage to the acetabular cartilage by a prominent femoral metaphysis. Acta Orthop Scand. 2000;71:370–5.PubMedCrossRefGoogle Scholar
  16. 16.
    McAndrew MP, Weinstein SL. A long-term follow-up of Legg-Calvé-Perthes disease. J Bone Joint Surg [Am]. 1984;66-A:860–9.Google Scholar
  17. 17.
    Mose K. Methods of measuring in Legg-Calvé-Perthes disease with special regard to the prognosis. Clin Orthop Relat Res. 1980;150:103–9.PubMedGoogle Scholar
  18. 18.
    Murphy SB, Tannast M, Kim Y-J, Buly RL, Millis MB. Debridement of the adult hip for femoroacetabular impingement: indications and preliminary clinical results. Clin Orthop. 2004;429:178–81.PubMedCrossRefGoogle Scholar
  19. 19.
    Nötzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J. The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement. J Bone Joint Surg Br. 2002;84:556–60.PubMedCrossRefGoogle Scholar
  20. 20.
    Peters CL, Erickson JA. Treatment of femoro-acetabular impingement with surgical dislocation and debridement in young adults. J Bone Joint Surg [Am]. 2006;88-A:1735–41.CrossRefGoogle Scholar
  21. 21.
    Siebenrock KA, Schoeniger R, Ganz R. Anterior femoro-acetabular impingement due to acetabular retroversion: treatment with periacetabular osteotomy. J Bone Joint Surg [Am]. 2003;85-A:278–86.Google Scholar
  22. 22.
    Sochart D. Poor results following internal fixation of displaced subcapital femoral fractures: complacency in fracture reduction. Arch Orthop Trauma Surg. 1998;117:379–82.PubMedCrossRefGoogle Scholar
  23. 23.
    Tanzer M, Noiseux N. Osseous abnormalities and early osteoarthritis: the role of hip impingement. Clin Orthop Relat Res. 2004;429:170–7.PubMedCrossRefGoogle Scholar
  24. 24.
    Tönnis D. Normal values of the hip of the hip joint for the evaluation of x-rays in children and adults. Clin Orthop. 1976;119:39–47.PubMedGoogle Scholar
  25. 25.
    Wenger DE, Kendell KR, Miner M, Trousdale RT. Acetabular labral tears rarely occur in the absence of bony abnormalities. Clin Orthop Relat Res. 2004;426:145–50.PubMedCrossRefGoogle Scholar

Copyright information

© Hospital for Special Surgery 2013

Authors and Affiliations

  • Matthew C. Wendt
    • 1
  • Joseph R. Cass
    • 1
  • Robert R. Trousdale
    • 1
  1. 1.Mayo ClinicRochesterUSA

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