The Garden classification of subcapital femoral neck fractures is the most widely used. It is simple and predicts the development of AVN 1,2. Garden described particular femoral neck and acetabular trabeculae patterns which can assist in recognising differences within this classification system2.
Garden stage I : undisplaced incomplete, including valgus impacted fractures
- medial group of femoral neck trabeculae may demonstrate a greenstick fracture
Garden stage II : undisplaced complete
- no disturbance of the medial trabeculae
Garden stage III : complete fracture, incompletely displaced
- femoral head tilts into a varus position causing its medial trabeculae to be out of line with the pelvic trabeculae
Garden stage IV : complete fracture, completely displaced
- femoral head aligned normally in the acetabulum and its medial trabeculae are in line with the pelvic trabeculae
In general, stage I and II are stable fractures and can be treated with internal fixation (head-preservation) and stage III and VI are unstable fractures and hence treated with arthroplasty (either hemi- or total arthroplasty) 3.
- 1. Garden RS. Low-angle fixation in fractures of the femoral neck. Bone & Joint Journal. 43-B (4): 647. href="http://bjj.boneandjoint.org.uk/content/jbjsbr/43-B/4/647.full.pdf"
- 2. Garden RS. Stability and union in sub capital fractures of the femur. Bone & Joint Journal. 46-B (4): 630. Pubmed
- 3. Mears SC. Classification and surgical approaches to hip fractures for nonsurgeons. Clin. Geriatr. Med. 2014;30 (2): 229-41. doi:10.1016/j.cger.2014.01.004 - Pubmed citation