Femoral Neck Fractures Garden I and Ii: Evaluation of the Deviation in Lateral View

Leonhardt, Natália Zalc; Melo, Lucas da Ponte; Nordon, David Gonçalves; Silva, Fernando Brandão de Andrade e; Kojima, Kodi Edson; Silva, Jorge Santos

doi:10.1590/1413-785220172502169349

Cited by 6 publications

(6 citation statements)

References 16 publications

(19 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Most Garden I and II fractures (79%) have varying degrees of posterior displacement in lateral X-ray radiographs. [22] In this study, the main valgus angle was 18° and the average posterior tilt angle was 19°, similar to previous reports [22][23][24] and close to the limit of acceptable reduction. [7] A preoperative posterior tilt ≥20° or anterior tilt >10° increases the risk of xation failure; [6,24] therefore, some doctors consider a neck-shaft angle between 130° and 150° and 0-15° of anteversion as acceptable reduction for displaced femoral neck fractures.…”

Section: Displacement and Prognosis Of Valgus-impacted Femoral Neck F...supporting

confidence: 91%

Finite element analysis of necessity of reduction and selection of internal fixation for valgus-impacted femoral neck fracture

Dai

Dou

et al. 2022

Computer Methods in Biomechanics and Biomedical Engineering

View full text Add to dashboard Cite

BackgroundAlthough valgus-impacted fractures don't displace obviously, a larger valgus angle and posterior tilt of the femoral head can cause hip joint dysfunction and femoral head necrosis. The optimal surgical approach for valgus-impacted femoral neck fractures remains controversial. This study compared the biomechanical characteristics of different treatment strategies based on nite element analysis. MethodsTen valgus-impacted femoral neck fractures were analyzed in terms of posterior tilt and valgus angle measured on X-ray radiographs. Using these data, we generated 7 nite element models that were compared in terms of von Mises stress distribution and displacement. ResultsIn the intact femur, von Mises stress was concentrated at the medial and inferior sides of the femoral neck. In valgus-impacted femoral neck fractures, von Mises stress was at the same locations but was 5.66 times higher than that in the intact femur. When 3 cannulated screws were used for internal xation, anatomic reduction diminished the stress at the fracture end from 140.6 to 59.14 MPa, although displacement increased from 0.228 to 0.450 mm. When the fracture was xed with a sliding hip screw (SHS) + cannulated screw, there was less stress at the fracture end and greater displacement with anatomic reduction than that without reduction (stress: 15.9 vs 37.9 MPa; displacement: 0.329 vs 0.168 mm). ConclusionsThe SHS + cannulated screw has superior biomechanical stability than 3 cannulated screws, and is recommended following anatomic reduction to treat valgus-compacted femoral neck fractures. BackgroundA valgus-impacted femoral neck fracture classi ed as Garden type I[1] has a posteriorly tilted femoral head, is relatively stable, associated with mild symptoms, and easily misdiagnosed. The optimal treatment approach for this type of fracture is controversial. Because of their stability (minimal displacement) they are treated conservatively sometimes. However, there is a high risk of further displacement and the relatively short femoral neck can lead to complications such as hip dysfunction and pain. [2][3][4] The necessity of reduction and method of internal xation are also debated. Some studies suggest that for Garden I and II fractures-in particular, valgus-impacted femoral neck fracturesintraoperative reduction does not in uence the success of the surgery. [5,6] It has also been argued that as valgus-impacted fractures can destabilize after reduction, there is no need for anatomic reduction. [7] Others recommend anatomic reduction because the fact that malreduction signi cantly increases the risk

show abstract

Section: Displacement and Prognosis Of Valgus-impacted Femoral Neck F...supporting

confidence: 91%

Finite element analysis of necessity of reduction and selection of internal fixation for valgus-impacted femoral neck fracture

Dai

Dou

et al. 2022

Computer Methods in Biomechanics and Biomedical Engineering

View full text Add to dashboard Cite

show abstract

“…In previous studies on Garden classi cation of femoral neck fracture, the existence of Garden TYPE I has been controversial (14,15).In this study, a total of 6 incomplete fractures based on radiographic evaluation. By observing its CT scan, only 1 patient looks like incomplete fracture and the patient was only 22 years old, similar to greendstick fracture.…”

Section: Discussionmentioning

confidence: 90%

Distribution Characteristics Of New AO Classification In Different Age Groups Of Patients With Femoral Neck Fracture

Jiang

Zhu

Feng

et al. 2021

Preprint

View full text Add to dashboard Cite

Objective The clinical and imaging data of patients diagnosed with femoral neck fractures (FNFs) in Xi 'an Honghui Hospital from 2018 to 2020.The epidemiological characteristics of these patients in different age groups were analyzed. Methods In this study, patients with femoral neck fracture hospitalized in Xi 'an Honghui Hospital from January 2018 to January 2021 were divided into four groups according to age: the young group (≤44 years old), the middle-aged group (45-59 years old),the young old group (60-74 years old), and the elderly group (≥75 years old) to analyze age,sex,side,injury mechanism,new AO classification and other features. A total of 2071 patients were included for analysis. Results There were 742 males (35.8%) and 1,329 females (64.2%).There were 1,106 patient s(53.4%) on the left side and 965 on the right side (46.6%).There were 1781 cases of low energy injury (86%) and 290 cases of high energy injury (14%), and the main injury mechanism was falling.The number of patients with femoral neck fracture in each year was 719 patients in 2018, 694 patients in 2019, and 661 patients in 2020, respectively. The number of patients showed a decreasing trend year by year, and the gender ratio and injury mechanism showed no significant trend of change. In the age group, the proportion of the young group was increasing year by year.Among the new AO classification, there were 1023 cases of B1.3, accounting for the highest proportion of 49.4%.The proportion of B2.2 was the highest in the young group (32.4%) .B1.3 and B2.2 were the main types in the middle-aged group, accounting for 31.7% and 32.0, respectively.B1.3 was dominant in the young old and elderly group (47.1% and 63.4%, respectively). Conclusion The new classification combines the classic classification, which is easier to remember. The stability of fracture is more carefully distinguished,which is conducive to guiding the surgical treatment of many stable femoral neck fractures in middle-aged and young old people. ORIF treatment can be used to delay the age of hip replacement.

show abstract

Section: Introductionmentioning

confidence: 99%

“…[ 6 ] One study found that sagittal plane deformity occurs in up to 79% of patients with femoral neck fractures first classified as Garden type I or II on AP radiographs. [ 7 ]…”

Section: Introductionmentioning

confidence: 99%

“…[ 1 , 2 , 8 , 9 ] By contrast, 2 other studies found no association between sagittal tilt on the lateral view and postoperative complications. [ 7 , 10 ] One possible explanation for the discrepant findings is that the described methods for assessing sagittal deformity may have limited reliability, particularly when dichotomizing fractures as “low-risk” and “high-risk.” Posterior tilt on the lateral radiograph is influenced by rotation and flexion of the femur. [ 11 ] While the measurement technique proposed by Palm et al [ 1 ] has been reported to have excellent inter-rater and intrarater reliability, it has never been externally validated and may not be an accurate representation of the actual femoral neck fracture sagittal tilt.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Sagittal deformity of Garden type I and II geriatric femoral neck fractures is frequently misclassified by lateral radiographs

Tiee

Golz

Kim

et al. 2023

OTA International: The Open Access Journal of Orthopaedic Trauma

View full text Add to dashboard Cite

Objectives: The objective of this study was to determine the validity and inter-rater reliability of radiographic assessment of sagittal deformity of femoral neck fractures.Design: This is a retrospective cohort study.Setting: Level 1 trauma center.Patients/Participants: Thirty-one patients 65 years or older who sustained low-energy, Garden type I/II femoral neck fractures imaged with biplanar radiographs and either computed tomography or magnetic resonance imaging were included.Main Outcome Measurements: Preoperative sagittal tilt was measured on lateral radiographs and compared with the tilt identified on advanced imaging. Fractures were defined as "high-risk" if posterior tilt was $20 degrees or anterior tilt was .10 degrees.Results: Of 31 Garden type I/II femoral neck fractures, advanced imaging identified 10 high-risk fractures including 8 (25.8%) with posterior tilt $20 degrees and 2 (6.5%) with anterior tilt .10 degrees. Overall, there was no significant difference between sagittal tilt measured using lateral radiographs and advanced imaging (P 5 0.84), and the 3 raters had good agreement between their measurements of sagittal tilt on lateral radiographs (interclass correlation coefficient 0.79, 95% confidence interval [0.65, 0.88], P , 0.01). However, for high-risk fractures, radiographic measurements from lateral radiographs alone resulted in greater variability and underestimation of tilt by 5.2 degrees (95% confidence interval [218.68, 8.28]) when compared with computed tomography/magnetic resonance imaging. Owing to this underestimation of sagittal tilt, the raters misclassified high-risk fractures as "low-risk" in most cases (averaging 6.3 of 10, 63%, range 6 2 7) when using lateral radiographs while low-risk fractures were rarely misclassified as high-risk (averaging 1.7 of 21, 7.9%, range 1 2 3, P 5 0.01).Conclusions: Lateral radiographs frequently lead surgeons to misclassify high-risk sagittal tilt of low-energy femoral neck fractures as low-risk. Further research is necessary to improve the assessment of sagittal plane deformity for these injuries.

show abstract

Femoral Neck Fractures Garden I and Ii: Evaluation of the Deviation in Lateral View

Cited by 6 publications

References 16 publications

Finite element analysis of necessity of reduction and selection of internal fixation for valgus-impacted femoral neck fracture

Finite element analysis of necessity of reduction and selection of internal fixation for valgus-impacted femoral neck fracture

Distribution Characteristics Of New AO Classification In Different Age Groups Of Patients With Femoral Neck Fracture

Sagittal deformity of Garden type I and II geriatric femoral neck fractures is frequently misclassified by lateral radiographs

Contact Info

Product

Resources

About