Garden classification of hip fractures

Last revised by Joshua Yap on 28 Feb 2023

The Garden classification of subcapital femoral neck fractures is the most widely used. It is simple and predicts the development of osteonecrosis 1,2. Garden described particular femoral neck and acetabular trabeculae patterns which can assist in recognizing differences within this classification system 2.

  • 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 IV are unstable fractures and hence treated with arthroplasty (either hemi- or total arthroplasty) 3.

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