Keller C S, Laros G S
Clin Orthop Relat Res. 1980 Oct(152):131-7.
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.
Garden对线指数对老年股骨颈骨折有用，在两个视图中，可接受的复位角度定义为155度至180度。手术室中可用的X线片质量可能无法准确测量该指数。作为替代方法，前后和内侧皮质移位超过2 mm可作为复位不满意的指标。由于复位不良与骨不连和缺血性坏死的高发生率相关，无法实现成人股骨颈骨折的可接受复位是切开复位的指征。由于后方移位也与愈合并发症的高发生率相关，这是切开复位的另一个指征。切开复位时进行植骨并仔细重塑远端骨折块可提供稳定性以促进愈合。股骨颈骨折的并发症发生率在年轻人和儿童中尤其高。在这些年龄组中，解剖复位对于尽量减少骨不连和缺血性坏死至关重要。如果一次轻柔的闭合手法复位未能实现解剖复位，对于40岁以下患者的移位股骨颈骨折，建议进行一期切开复位。
