Femoral neck fracture: the reliability of radiologic classifications

Cazzato, G.; Oliva, Maria Serena; Masci, Giulia; Vitiello, Raffaele; Smimmo, Alessandro; Matrangolo, Maria Rosaria; Palmacci, Osvaldo; D'Adamio, Stefano; Ziranu, Antonio

doi:10.1186/s12891-022-05007-3

Cited by 7 publications

(8 citation statements)

References 21 publications

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“…The type of fractures reflects the severity of the disease and determines the treatment programs. At present, the most widely used FNF classification method is Garden classification based on the fracture line characteristics and displacement degree: Garden I and II FNF are undisplaced FNF; Garden III and IV FNF are displaced FNF; displacement degree of Garden I–IV increase in sequence [ 15 ]. In recent years, many doctors have found out some shortcomings in Garden classification in clinical application [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…At present, the most widely used FNF classification method is Garden classification based on the fracture line characteristics and displacement degree: Garden I and II FNF are undisplaced FNF; Garden III and IV FNF are displaced FNF; displacement degree of Garden I–IV increase in sequence [ 15 ]. In recent years, many doctors have found out some shortcomings in Garden classification in clinical application [ 15 ]. Frandsen et al [ 29 ] have asked 8 doctors to perform separate Garden classification for 100 cases of FNF.…”

Section: Discussionmentioning

confidence: 99%

“…Garden classification, a commonly used classification method for FNF in the clinic, was proposed by Professor RS Garden in 1961 [ 12 , 13 ]. In spite of arguments, Garden classification is still the most widely used FNF classification method so far [ 14 , 15 ]. RS Garden classified FNF into four types based on completeness and displacement degree of FNF: Garden I is defined as incomplete and undisplaced FNF, Garden II as complete and undisplaced FNF, Garden III as complete and partially-displaced FNF, and Garden IV as complete and completely-displaced FNF.…”

Section: Introductionmentioning

confidence: 99%

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Does Garden type I incomplete femoral neck fracture really exist in older adults? To evaluate the stability and consistency of Garden classification

et al. 2022

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Background Accurate classification of femoral neck fracture (FNF) is crucial for treatment plan and therapeutic outcomes. Garden classification is commonly used in the clinic, but its stability and consistency remain controversial. The aim of this study was to evaluate the stability and consistency of Garden classification based on X and CT images, and to analyze whether it is valid for Garden I in the elderly. Methods X-ray and CT images from 886 elderly patients with FNF were collected, four orthopaedic surgeons and four radiologists evaluated these images independently, and determined the fracture type based on Garden classification. Three months later, The exercise was repeated and the results were compared based on 4 types Garden classification (I, II, III and IV) and 3 types Garden classification (I + II, III and IV). Kappa was used to measure inter- and intraobserver agreement. The patients with Garden I incomplete FNF confirmed by 8 observers together based on images combined with medical history were compared with the intraoperative results. Results Four types Garden classification, there was little consistency inter- and intraobservers (Kappa from 0.18 to 0.43) based on X-ray images, while professors consistency (0.56 to 0.76) was higher than residents (0.28 to 0.35) based on CT. 3 types Garden classification showed almost perfect agreement inter- and intraobservers, which ranged from 0.76 to 0.90. Totally 52 patients were diagnosed as Garden I, 38 of whom underwent arthroplasty. All surgical cases showed complete fracture during operation. Conclusions There was low consistency and repeatability in 4 types Garden classification (I, II, III and IV), while 3 types Garden classification (I + II, III and IV) had high consistency among observers. In the elderly, all undisplaced femoral neck fracture may be Garden II, no Garden I.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Does Garden type I incomplete femoral neck fracture really exist in older adults? To evaluate the stability and consistency of Garden classification

et al. 2022

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“…In the SFR, femoral neck fractures are classified according to the simplified OTA/AO classification 16 as nondisplaced (31-B1), basicervical (31-B2), or displaced (31-B3), on the basis of an anteroposterior radiograph, which has been shown to have moderate interobserver reliability 17 . The treatment is entered by the treating physician and transformed to its Nordic Medico-Statistical Committee (NOMESCO) Classification of Surgical Procedures (NCSP) procedure code 18 .…”

Section: Methodsmentioning

confidence: 99%

Conversion to Arthroplasty After Internal Fixation of Nondisplaced Femoral Neck Fractures

Lagergren

Mukka

Wolf

et al. 2022

Journal of Bone and Joint Surgery

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Background: Although most nondisplaced or minimally displaced femoral neck fractures are routinely treated with internal fixation, high rates of secondary surgical procedures are common, especially in the elderly population. Primary arthroplasty in elderly patients has been proposed as an alternative treatment to reduce the need for a secondary surgical procedure. The objective of this study was to describe the rate of conversion to arthroplasty within 5 years after internal fixation of nondisplaced femoral neck fractures in patients ‡60 years of age. Methods:In this observational cohort study of prospectively collected data from the Swedish Fracture Register (SFR) between 2012 and 2018, cross-matched with the Swedish Arthroplasty Register (SAR), 5,428 nondisplaced femoral neck fractures in patients ‡60 years of age were included. Competing risk analysis was used to estimate conversion rates to arthroplasty and mortality in various age groups at 1, 2, and 5 years.

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“…X-ray photography has the advantages of simple operation, low radiation dose, mature technology and relatively low cost, which plays an important role in the diagnosis and postoperative evaluation of femoral neck fracture, and is the preferred imaging examination in hip joint disease examination [ 11 – 13 ]. Commonly used photography positions include hip anterior–posterior and cross-table lateral views [ 14 – 16 ]. The cross-table lateral view is complex, especially for patients with hip injuries.…”

Section: Introductionmentioning

confidence: 99%

Clinical application of modified hip joint lateral position in femoral neck fracture

Liu,

Gao,

Zhong

et al. 2023

J Orthop Surg Res

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Background To show the femoral neck better in hip lateral view of X-ray, we design a modified hip lateral view and then investigate the value in femoral neck fractures. Methods CT images of 10 normal hip joints for 3D reconstruction were selected, the Mimics Medical 21.0 was used, and rotating the proximal femur was to find the most suitable angle for showing the femoral neck well, designed the modified lateral view according to this angle. We collected 35 healthy cases and 35 femoral neck fractures as the normal and fracture group. And two groups were all taken hip anteroposterior view, cross-table lateral view and modified lateral view, which were analyzed by two radiologists to score the anatomical structures of the articular surface, femoral head, head neck junction, femoral neck, basal region and intertrochanteric region. Friedman test was used to analyze the score of femoral neck at different angles. T test and Wilcoxon signed-rank test were to compare inter-groups. Results The modified lateral view was designed as follows: The subjects were supine, with the sagittal axis biased toward the healthy side at an angle of approximately 20° to the long axis of the examination table, the hip joint flexed at 45°, the lower extremity abducted at 40°, the centerline inclined 45° toward the head and the centerline aligned with the center of the groin. The modified lateral view showed the femoral head, head neck junction and femoral neck more clearly than the cross-table lateral view, but the cross-table lateral view showed the femoral neck basal and intertrochanteric region better. In addition, the time of taking the modified lateral view was significantly less than the cross-table lateral view (normal group: 0.789 min ± 0.223 vs 0.623 min ± 0.207, P < 0.001; fracture group: 1.131 min ± 0.362 vs 0.946 min ± 0.390, P < 0.001). Conclusions The modified lateral view can obtain a standard sagittal image of femoral neck, which can show the dislocation and angulation of the sagittal femoral neck fracture clearly, and improve the accuracy of diagnosis. And it is more convenient and easier for patients to cooperate, which is worthy promoting and applying in clinical work.

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Femoral neck fracture: the reliability of radiologic classifications

Cited by 7 publications

References 21 publications

Does Garden type I incomplete femoral neck fracture really exist in older adults? To evaluate the stability and consistency of Garden classification

Does Garden type I incomplete femoral neck fracture really exist in older adults? To evaluate the stability and consistency of Garden classification

Conversion to Arthroplasty After Internal Fixation of Nondisplaced Femoral Neck Fractures

Clinical application of modified hip joint lateral position in femoral neck fracture

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