Indications for open reduction of femoral neck fractures.

The Garden alignment index is useful for femoral neck fractures in the aged and defines an acceptable reduction as 155 degrees-180 degrees in both views. The quality of films available in the operating room may not permit accurate measurements of the index. As a substitute, anterior and medial cortical displacement of more than 2 mm may be used as a measure of unsatisfactory reduction. Because malreduction is associated with a high incidence of nonunion and avascular necrosis, inability to achieve acceptable reduction of an adult femoral neck fracture is an indication for open reduction. Since posterior communication is also associated with a high rate of healing complications, it is another indication for open reduction. Bone grafting and careful reshaping of the distal fracture fragment at open reduction can provide stability to promote healing. The incidence of complication of femoral neck fracture is especially high in young adults and children. Anatomic reduction is essential in these age groups to minimize nonunion and avascular necrosis. Primary open reduction is advisable for displaced femoral neck fractures in patients less than 40 years of age if a single gentle closed manipulation fails to provide anatomic reduction.