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

Cronin, Patrick K. MD*; Freccero, David M. MD*; Kain, Michael S. MD*; Marcantonio, Andrew J. DO, MBA; Horwitz, Daniel S. MD; Tornetta, Paul III MD*

Journal of Orthopaedic Trauma: March 2019 - Volume 33 - Issue 3 - p 116–119
doi: 10.1097/BOT.0000000000001360
Original Article

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.

*Department of Orthopaedic Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA;

Department of Orthopaedic Surgery, Lahey Medical Center, Burlington, MA; and

Department of Orthopaedic Surgery, Geisinger Health Systems, Danville, PA.

Reprints: David Freccero, MD, Department of Orthopaedic Surgery, Boston Medical Center, Boston University School of Medicine, 850 Harrison Avenue, Dowling 2N, Boston, MA 02118 (e-mail:

The authors report no conflict of interest.

Accepted October 09, 2018

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