Subcapital fracture

Last revised by Dr Yuranga Weerakkody on 19 Jun 2022

Subcapital fracture is the most common type of intracapsular neck of femur fracture. The fracture line extends through the junction of the head and neck of femur.

Classification

Although many classifications are proposed Garden classification and Pauwel classification are generally followed from a practical point of view as these two systems take into consideration the stability of the fractures.

Pre-reduction

Garden classification is based on the pre-reduction displacement of the femoral head. Further, the displacement is graded as per the position of the principal (medial) compressive trabeculae.

Types
  • type I: is incomplete, stable and impacted
  • type II: complete, stable and undisplaced
  • type III: complete, unstable and partially displaced 
  • type IV: complete, unstable and fully displaced
Post-reduction

Pauwel classification is based on post-reduction angulation of fracture line to the horizontal evaluated on a AP radiograph. Lesser the angulation more stable the fracture with a better a prognosis.

Types
  • type I: < 30 degrees
  • type II: 30-50 degrees
  • type III: > 50 degrees

Complications

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Cases and figures

  • Case 1
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  • Case 2
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  • Case 3
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  • Case 4
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  • Case 5: subacute
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