In situ fixation of nondisplaced intracapsular fractures of the proximal femur.

The Garden classification of femoral neck fractures is used most commonly in the literature. However, there is difficulty in differentiating the four types of fractures as shown by studies of interobserver reliability. Therefore, it may be more accurate to classify femoral neck fractures as nondisplaced (Garden Types I and II) or displaced (Garden Types III and IV). Nondisplaced femoral neck fractures (Garden Types I and II) should be stabilized internally using multiple (two to four) lag screws. Care should be taken to avoid any loss of reduction during the surgical procedure. Decompression of the hematoma by needle aspiration or capsulotomy has been shown to reduce intracapsular pressures and improve blood flow in the femoral head. However, from the practical point of view, there currently is insufficient evidence to justify capsulotomy. Complications after in situ fixation of nondisplaced femoral neck fractures can be divided into two categories: general complications relating to comorbidities, surgery, or anesthesia; and complications after the use of cannulated screws such as unrecognized screw penetration of the hip, infection, nonunion, and osteonecrosis.