Intracapsular fractures of the neck of femur. Parallel or crossed garden screws?

Abstract

The results of treatment in 242 patients with intracapsular fractures of the neck of femur treated with Garden screws are presented with reference as to whether the screws were crossed or parallel. The incidence both of nonunion and of avascular necrosis was less in those fractures treated with parallel screws. The outcome was also superior if the reduction was good.

Comparative results of percutaneous cannulated screws, dynamic compression type plate and screw for the treatment of femoral neck fractures

“…However, there are studies that report 8-16% AVN in similar type of fractures. [5,30,[39][40][41] Barnes et al [8] reported an AVN rate of 22% and Ort et al [42] reported an AVN rate of 24% in femoral neck fractures treated by DHS. We found higher rates (30% in our Group II patients with DHS), which may have been caused by selection bias.…”

Fluoroscopy-Based Surgical Navigation versus Fluoroscopic Guidance to Control Guide Wire Insertion for Osteosynthesis of Femoral Neck Fractures

“…Correct screw position seems to be essential in order to address biomechanical issues [3][4][5]. This includes correct alignment of the screws with the femoral neck axis as well as parallel alignment of the screws [6].…”

Fixed angle devices versus multiple cancellous screws: What does the evidence tell us?

“…In a biomechanical study, Pauwel screws, which include a trochanteric lag screw followed by screws placed parallel to the femoral neck, were 70% stiffer than parallel screws [14]. However, in a retrospective review, 23% of patients treated with parallel screws developed nonunion or avascular necrosis compared to 59% of those treated with crossed/Pauwel screws [15]. In a subgroup analysis of the study by Liporace et al, mechanical failure occurred in 60% of fractures fixed with crossed/Pauwel screws compared to 13% of those fixed with parallel screws [16].…”