Femoral Neck Fracture Classification

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, 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.

• Garden III & IV
• Treatment = primary prosthetic replacement.
• Hemiarthroplasty for patients without underlying arthritis or risk of dislocation (Parkinson's, prior stroke, neuro impairment).
• THA for 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.