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Femoral Neck Fracture Classification

 Nondisplaced femoral neck fracture image  Nondisplaced 
  • Garden 1 &2
  • Treatment = in-situ parallel screw fixation. 
  • C-arm, cannulated screw set, supine on fx table.  Place guide pin in center-center location.  3 screws total, insignificant mechanical advantage to adding more implants.
  • See also AO Classification.
Displaced femoral neck fracture image

Displaced, Young active patient

  • Garden III & IV
  • Treatment = closed reduction and internal fixation.
  • Fixation is generally performed with 3 parallel screws.
  • Open reduction is indicated if closed reduction is unsatisfactory.
  • Young patients with isolated, high energy femoral neck fracture are at high risk for nonunion & AVN. (Swiontkowski MF, JBJS 1984;66A:837).
  • Consider dynamic hip screw with derotational screw for vertical or severely comminuted fractures.
  • 25% nonunion risk(Rx-valgus osteotomy)
  • 30% osteonecrosis risk(Rx=arthroplasty).
  • See also AO Classification.
Displaced fermoral neck fracture

Displaced, Elderly inactive patient 

  • Garden III & IV
  • Treatment = primary prosthetic replacement.
  • Hemiarthroplasty for patients without underlying arthritis or risk of dislocation (Parkinson's, prior stroke, neuro impairment).
  • THAfor patients with underlying arthritis.
  • Hemiarthroplasty generally performed with a cemented modular unipolar prosthesis. The clinical benefits of bipolar designs are questionable and are generally not consider to warrant the added expense.
  • Surgery should be performed ASAP after medical clearance, usually within 24-48 hours. Medical conditions should be stabilized before surgery. (Sexson SB, JOT 1988;1:298)
  • Anestesia: type has not been shown to affect outcomes. (Davis FM, Br J Anaesth 1987;59:1080)
  • See also AO Classification.