Research progress in treatment of Garden type <b>Ⅳ</b> femoral neck fractures in young adults_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Tailu , QI Bo , XU Zhi ,  XU Yongqing

Department of Orthopedics, the 920th Hospital of Joint Logistics Support Force of Chinese PLA, Kunming Yunnan, 650032, P. R. China;

Corresponding?author：

XU Yongqing, Email: xuyongqingkm@163.net

Keywords：

Young adults; Garden type Ⅳ femoral neck fracture; internal fixation; blood supply reconstruction; osteonecrosis of the femoral head

DOI：

10.7507/1002-1892.202601098

Video：

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Objective To elucidate the therapeutic challenges and recent advances in managing Garden type Ⅳ femoral neck fractures in young adults through the perspective of anatomical blood supply, identifying current limitations and proposing future research directions for optimizing clinical treatment strategies. Methods A comprehensive review of recent domestic and international literature on Garden type Ⅳ femoral neck fractures in young adults was conducted, focusing on the anatomical basis of femoral neck vascularization, innovations in internal fixation techniques, vascular reconstruction methods, and applications of adjunct technologies. Results The treatment of Garden type Ⅳ femoral neck fractures in young adults has evolved from internal fixation toward an integrated biomechanical and biological approach. The distinct anatomy of the femoral neck and the vulnerability of femoral head perfusion render the management of Garden type Ⅳ fractures particularly challenging in young adults. Enhanced internal fixation systems have significantly improved stability through optimized biomechanical configurations. Vascularized (or muscle-pedicle) bone grafting offers an effective biological reconstruction strategy for high-risk patients. Conclusion Individualized comprehensive treatment, grounded in the understanding of femoral neck vascular anatomy, is crucial for improving outcomes. Future efforts should integrate intelligent surgical planning and biological therapeutics to further enhance therapeutic efficacy.

Citation： CHEN Tailu, QI Bo, XU Zhi, XU Yongqing. Research progress in treatment of Garden type Ⅳ femoral neck fractures in young adults. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(7): 1128-1135. doi: 10.7507/1002-1892.202601098 Copy

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1. 馬路遙, 孫雪傲, 譚青駿, 等. 增加一枚橫向螺釘固定Pauwels Ⅲ型股骨頸骨折的有限元分析. 中國修復重建外科雜志, 2025, 39(5): 584-591.
2. 張改, 陳玉梅, 李淑芳, 等. 5117例股骨頸骨折患者流行病學調查分析. 天津護理, 2021, 29(5): 505-508.
3. Huang Y, Lin D, Shangguan S, et al. Complications and risk factors after internal fixation of femoral neck fractures in young and middle-aged patients. Eur J Trauma Emerg Surg, 2025, 51(1): 304. doi: 10.1007/s00068-025-02991-8.
4. Liang C, Cao Y, Lin Z, et al. Open reduction and internal fixation of irreducible displaced femoral neck fracture with femoral neck system: a preliminary study. BMC Musculoskelet Disord, 2023, 24(1): 826. doi: 10.1186/s12891-023-06839-3.
5. 王海, 葉君健, 陳春永, 等. 空心拉力螺釘加內側支撐鋼板固定結合縫匠肌蒂骨瓣治療青壯年股骨頸骨折. 中國修復重建外科雜志, 2022, 36(2): 163-169.
6. Maria E, Amoako-Adjei O. A comprehensive review of hip fractures in sub-saharan Africa: Contextual challenges, outcomes, and pathways to improved care. Cureus, 2025, 17(11): e97653. doi: 10.7759/cureus.97653.
7. Zhou X, Jia J, Lian K. Structural characteristics, biomechanics and clinical significance of calcar femorale: A review. Medicine (Baltimore), 2024, 103(21): e38323. doi: 10.1097/MD.0000000000038323.
8. Zhao K, Liu Y, Li H. Reliability of 3D quantitative displacement of femoral neck fracture site measured via CT and its correlation with femoral head avascular necrosis: a retrospective cohort study. Quant Imaging Med Surg, 2026, 16(2): 149. doi: 10.21037/qims-2025-1483.
9. Li Z, Wang H, Cao T, et al. Changes in serum NO, ET-1, and VEGF after cannulated screw fixation in patients with femoral neck fractures and their relationship with femoral head necrosis. Front Physiol, 2025, 16: 1603323. doi: 10.3389/fphys.2025.1603323.
10. Zhao D, Qiu X, Wang B, et al. Epiphyseal arterial network and inferior retinacular artery seem critical to femoral head perfusion in adults with femoral neck fractures. Clin Orthop Relat Res, 2017, 475(8): 2011-2023.
11. 羅歡, 李川, 蔡興博, 等. 臀下動脈來源的股骨頭后上支持帶動脈觀察. 中華關節外科雜志 (電子版), 2024, 18(4): 439-444.
12. Collin PG, D’Antoni AV, Loukas M, et al. Hip fractures in the elderly-: A Clinical Anatomy Review. Clin Anat, 2017, 30(1): 89-97.
13. 耿寬. 應用DSA觀察股骨頸骨折患者血管損傷和早期預后的相關性研究. 唐山: 華北理工大學, 2024.
14. 吳升輝, 繆語, 朱曉中, 等. 股骨頸骨折對局部血供的損傷及評估——解剖基礎及其臨床運用進展. 中國骨傷, 2023, 36(3): 294-298.
15. Putnam SM, Collinge CA, Gardner MJ, et al. Vascular anatomy of the medial femoral neck and implications for surface plate fixation. J Orthop Trauma, 2019, 33(3): 111-115.
16. 張立毅, 陶可, 陳堅, 等. 股骨頭圓韌帶生物學特征及臨床研究進展. 中華骨與關節外科雜志, 2020, 13(2): 172-176.
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Chinese Journal of Reparative and Reconstructive Surgery

Research progress in treatment of Garden type Ⅳ femoral neck fractures in young adults

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