Reunderstanding of Garden Type I Femoral Neck Fractures by 3-dimensional Reconstruction

Abstract

Garden type I fractures include incomplete fractures and impacted fractures. With advances in scientific technology and medical treatment, certain deficiencies of the Garden classification have become apparent. The authors hypothesized that the incidence of incomplete femoral neck fractures was low and that impacted femoral neck fractures were not undisplaced and stable fractures. A new method was developed to precisely measure the spatial displacement of the femoral head in impacted femoral neck fractures. Between 2008 and 2011, nine hundred sixty-six patients with femoral neck fractures were treated, 48 of whom had Garden type I fractures, as seen on anteroposterior radiographs. Seven fractures were classified as incomplete on radiographs; however, after 3-dimensional reconstruction, 3 were classified as incomplete and 4 as complete fractures. Furthermore, the remaining 41 Garden I fractures that were classified as impacted on radiographs showed large spatial displacement on 3-dimensional reconstruction. The average rotational displacement of the femoral head was 19.29°±10.51°, and the average displacements of the femoral head center and the lowest point of the fovea capitis were 8.76±4.45 and 14.39±8.08 mm, respectively. This study showed that the incidence of incomplete femoral neck fractures was low. Impacted femoral neck fractures showed variable degrees of displacement and were not undisplaced, stable fractures. Garden classification for impacted femoral neck fractures has certain limitations. Impacted femoral neck fractures should be differentiated from Garden type I fractures so clinicians can select appropriate treatments for these fractures.

A special superior cortex compressive fracture of femoral neck

“…There is still disagreement on the existence of this type of fracture. [ 3 , 4 ] Herein, we report 2 patients with the Garden type I femoral neck fractures and confirm the real existence of it. This study was carried out in accordance with the guidelines of the Declaration of Helsinki.…”

“…There is still disagreement on the existence of Garden type I fractures. [ 3 , 4 ] A review from Raaymakers [ 7 ] even considered that the really nondisplaced femoral neck fracture does not exist. With the development of radiology, CT scans allow for more accurate diagnosis of the displacement of femoral neck fractures.…”

On-table decision-making in intracapsular hip fracture surgery: mid-term results of a pilot study

“…Moreover, it is has been shown in recent work that most Garden stage I fractures-undislocated fractures per definitionare neither undislocated nor stable when studied using three-dimensional CT technology. This study especially revealed significant posterior and rotational displacement [5]. A missed or underestimated posterior and rotational displacement may result in impaired blood supply to the femoral head due to a kinking of the retinacular nutrient vessels [27].…”

“…Moreover, recent 3D-CT-based research on Garden stage 1 fractures has demonstrated that there is considerable rotational displacement in most patients. They concluded that most Garden stage 1 fractures are neither undisplaced nor stable [5]. Moreover, the preoperative radiographs of unstable fracture types should be understood as a snapshot.…”

Correlation Between Residual Displacement and Osteonecrosis of the Femoral Head Following Cannulated Screw Fixation of Femoral Neck Fractures

“…Currently, no superior method existed to measure the residual displacement of the femoral head. A new method that was published in 2013 12 was developed by our team to measure the preoperative displacement of Garden stage I fractures based on 3-dimensional reconstruction software. In our study, Garden stage I femoral neck fractures were found with some degrees of displacement that was invisible in plain x-ray.…”