Garden 1 and 2 Femoral Neck Fractures Collapse More Than Expected After Closed Reduction and Percutaneous Pinning

J Orthop Trauma. 2019 Mar;33(3):116-119. doi: 10.1097/BOT.0000000000001360.


Objectives: To report on the final displacement after in situ percutaneous pinning for Garden type 1 and 2 fractures in height, femoral neck fracture collapse, and loss of offset.

Design: Retrospectively reviewed case series.

Setting: Three Academic Medical Centers. Boston University Medical Center (Level 1 Trauma Center), Lahey Hospital and Medical Center (Level 2 Trauma Center), and Geisinger Medical Center (level 2 Trauma Center).

Patients/participants: One hundred thirty skeletally mature patients with 130 fractures (78 garden 1 and 52 garden 2) who were treated between January 2000 and January 2014 at participating hospitals with percutaneous pinning with a cannulated screw system to successful union after sustaining an intracapsular femoral neck fracture without complete displacement.

Intervention: In situ percutaneous pinning with 3 cannulated, partially threaded screws in an inverted triangle orientation.

Main outcome measurements: Femoral neck fracture collapse (mm), femoral height shortening (mm), and femoral offset shortening (mm).

Results: A total of 130 patients (81F, 49M), average age 72 years, sustained 78 Garden 1 and 52 Garden 2 femoral neck fractures. Maximal collapse occurred in the plane of the femoral neck. Thirty-three of 78 (42%) Garden 1 fractures and 33/52 (63%) Garden 2 fractures demonstrated >10 mm fracture collapse. The range of displacements was 0-39 mm as measured along the plane of the femoral neck.

Conclusions: Garden 1 fractures collapse less frequently than Garden 2 fractures, but both have high rates of fracture collapse when treated to union with in situ percutaneous pin fixation.

Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Bone Screws
  • Closed Fracture Reduction / adverse effects*
  • Female
  • Femoral Neck Fractures / physiopathology
  • Femoral Neck Fractures / surgery*
  • Femur Neck / physiopathology
  • Femur Neck / surgery*
  • Fracture Fixation / adverse effects*
  • Fracture Fixation / methods
  • Fracture Healing
  • Fractures, Compression / etiology*
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies