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X-rays for Femoral Neck Fractures

- See:
       - Calcar Femorale:
       - Garden I & II:
       - Garden III & IV:
       - Garden's Alignment Index:
       - Pathologic Hip Fractures:
       - Radiology of the Hip:
       - Sigh Index

- Radiographs:
    - AP & Lateral of Ipsilateral Femur + Internal Rotation View;
    - Lateral x-ray: of affected limb on the stretcher while good limb is flexed upto obtain the proper angle;
            - lateral view: scrutinized for post. femoral neck comminution;
            - do not order frog leg pts suspected of having a hip frx;
- Classification:
    - Garden I & II:
    - Garden III & IV:
    - Garden's Alignment Index:

- Assessment of Risk of Non-union: (using modified Pauwel's method);
      - see: femoral neck non-union:
      - modified Pauwel's method classifies frx as  horizontal, transverse, or vertical, according  to direction of frx on femoral head;
      - 11/11 Garden II frx w/ horizontal frx line had non-union;
      - 2/5 Garden II frx w/ vertical frx line had non-union;
      - 6/14 Garden III frx w/ vertical frx line had non-union;
      - 2/5 Garden IV frx w/ vertical frx line had non union;
      - references:
           - Nonunion of Subcapital Femoral Neck Fractures.  
           - The Pauwels classification for intracapsular hip fractures: Is it reliable?
           - Biomechanical analysis of a novel femoral neck locking plate for treatment of vertical shear Pauwel's type C femoral neck fractures.

- Non-displaced Frx: - if plain radiographs are negative, consider MRI for immediate interpretation or bone scan after three days;

- Radiographic Features:
    - normal radiographic anatomy of the femoral head and neck reveal a convex outline of femoral head joining the concave outline of femoral neck
          on all radiographic projections;
          - this outline produces the image of an S or a reversed S curve;
          - hence, the outline of the femoral neck is never tangent to the outline of the femoral head in a reduced femoral neck fracture;
    - posterior comminution:
          - frxs w/ posterior comminution have higher prevalence of non-union;
          - degree of posterior comminution is most evident lateral radiograph;
          - when treating fractures with a large amount of posterior comminution, surgeon should place the superior & posterior screws along calcar femorale to resist posterior collapse;

- Misc:
    - single ramus fracture is commonly seen in elderly age groups, in whom falls are common;
    - in this age group its important to make important distinction between frx of pelvis & undisplaced or impacted frx of neck of femur;
    - finding tenderness over the pubic bone may make diagnosis apparent

Vertically oriented femoral neck fractures: mechanical analysis of four fixation techniques.

Vertical shear fractures of the femoral neck. A biomechanical study

Results of Internal Fixation of Pauwels Type-3 Vertical Femoral Neck Fractures

Analysis of Initial Injury Radiographs of Occult Femoral Neck Fractures in Elderly Patients: A Pilot Study

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