Open Reduction and Internal Fixation and Intraoperative Exploration of the Superior Retinacular Arterial System in Young Adults Garden III Femoral Neck Fracture: A 10 Case Report

Abstract

At present, there is no uniform standard for the treatment of femoral neck fractures (FNFs) in young adults, and the current strategy is inclined to the native hip joint preservation. Femoral neck fractures in young adult are mostly caused by high-energy violence, and the blood supply of femoral head is severely damaged, which is prone to secondary femoral head avascular necrosis. In this article, we report 10 cases of young adult Garden III FNF treated with open reduction and internal fixation (ORIF) and microsurgical exploration of the superior retinacular vessels from 2015 to 2018, to more intuitively understand the involvement of superior retinacular vessels after displaced FNF in young adults. The results show that the SRA injury of Garden III FNF could be categorized into 3 types (type A–C), type A (6/10): the SRA vessels were kept intact, while they were pulled or compressed by displaced fracture fragment and could be revascularized by reduction; type B (3/10): the SRA vessels were avulsed with the superior retinaculum attachment avulsion fracture and could not be revascularized by reduction; and type C (1/10): the SRA vessels were ruptured, and the remnant of the vessel is present, which can be revascularized by vascular anastomosis. The previously mentioned results showed that the vascular damage of femoral head in Garden III FNF is quite complicated and might have the potential for being further classified into several subtypes.

Clinical observation and finite element analysis of cannulated screw internal fixation in the treatment of femoral neck fracture based on different reduction quality

“…However, in practice, complete anatomical reduction is difficult to achieve, especially with closed reduction methods. In addition, anatomical reduction has the potential to increase operative time and surgical trauma, thus affecting later fracture healing [ 12 ]. In 2013, Gotfried [ 13 ] proposed a new reduction method to introduce the concepts of “positive buttress” and “negative buttress.” It was preliminarily found that positive buttress could reduce the incidence of postoperative complications, and this method was easy to operate and economical and practical.…”

The application of the 150° oblique tangential fluoroscopic view to detect the posterosuperior femoral neck screw in–out–in intraoperatively

“…The posterosuperior screw was “in–out–in” near the area where the superior retinacular artery enters the femoral neck, which means that there is a high risk of screw perforation invading the artery 16 . Due to the effects of the iatrogenic injury on the intraosseous vascular system, the blood supply of the femoral head is severely deteriorated, leading to non-union and secondary femoral head avascular necrosis 24 , 25 . Yuan demonstrated that the incidence of avascular necrosis and revision surgery in hips with and without IOI screws was 6% and 6%, respectively; however, due to the width of the confidence intervals, a true clinical difference could not be excluded 6 .…”

Experimental analysis of femoral head intraosseous vascular anastomosis in the treatment of porcine subcapital femoral neck fractures

“…In Garden IV fractures, complete displacement resulted in injury to all retinacular arteries in all three groups. Wang et al investigated the superior retinacular arteries in 10 cases of Garden III femoral neck fractures and found entrapment of the superior retinacular artery in six cases [ 13 ]. In such cases, arterial blood flow can be restored by reducing fractures.…”