From the Department of Orthopaedic Surgery, Kaiser Moanalua Medical Center (Okike), and the Department of Orthopaedic Surgery, Univeristy of Hawaii John A. Burns School of Medicine (Okike and Hasegawa), Honolulu, HI.
J Am Acad Orthop Surg. 2021 Feb 15;29(4):e154-e164. doi: 10.5435/JAAOS-D-20-00349.
Nondisplaced (Garden I and II) femoral neck (FN) fractures are commonly encountered by the practicing orthopaedic surgeon. Although these fractures are primarily classified based on the AP radiograph, the lateral radiograph should be closely scrutinized as well because posterior tilt has emerged as a consistent predictor of fixation failure. Internal fixation has for many years been the standard of care, with both cannulated screws and the sliding hip screw representing acceptable options. However, the outcomes after fixation of Garden I and II FN fractures have not been uniformly positive, with the rates of revision surgery ranging from 8% to 27%. Complications after fixation of nondisplaced FN fractures include nonunion, fixation failure, osteonecrosis, and femoral shortening causing inferior hip function. For these reasons, arthroplasty is increasingly considered a viable option in the treatment of these fractures, especially in the presence of factors that predispose to failure after fixation. Novel devices for FN fixation have recently been developed, although clinical data supporting their use are sparse at the present time.
无移位（Garden I 和 II）股骨颈（FN）骨折在骨科医生的日常工作中较为常见。尽管这些骨折主要基于前后位 X 线片进行分类，但也应仔细观察侧位 X 线片，因为后倾已成为固定失败的一个一致预测因素。多年来，内固定一直是标准的治疗方法，空心螺钉和滑动髋螺钉都是可接受的选择。然而，Garden I 和 II 型 FN 骨折固定后的结果并不完全理想，翻修手术的比例为 8%至 27%。固定无移位 FN 骨折后的并发症包括骨不连、固定失败、骨坏死和股骨缩短导致髋关节功能下降。由于这些原因，关节置换术越来越被认为是这些骨折的一种可行治疗选择，尤其是在存在固定失败倾向因素的情况下。最近开发了用于 FN 固定的新型装置，但目前支持其使用的临床数据还很有限。
