Femoral Neck Fractures, Garden Classification
Introduction[edit | edit source]
The Garden classification is the most commonly used to classify intracapsular femoral neck fractures. It is simple and predicts the development of Avascular necrosis of the femoral head. Garden splits into four categories depending on the severity of the fracture and the degree of displacement.
Classification of Hip Fractures[edit | edit source]
The fractures are graded, depending on the type, pattern and whether or not there is displacement of the bone:
- Type I is an incomplete fracture or valgus impacted fracture.
- Type II is a complete fracture without displacement.
- Type III is a complete fracture with partial displacement of fracture fragments.
- Type IV is a complete fracture with total displacement of fracture fragments, allowing the femoral head to rotate back to its anatomical position within the acetabulum.
Surgical Treatment[edit | edit source]
Surgery may be indicated depending on the type of fracture. In general:
- Garden stage I and II are stable fractures and can be treated with internal fixation (head-preservation) eg Dynamic hip screw DHS
- Garden stage III and IV are unstable fractures and hence treated with hemi or total hip replacement.
Other Classifications Systems[edit | edit source]
Include, but not limited to:
1. Simplified Garden Classification
- Nondisplaced: Includes Garden I and II
- Displaced: Includes Garden IIII and IV
2, Pauwels Classification: (based on vertical orientation of fracture line)
- Type I: < 30 deg from horizontal
- Type II: 30 to 50 deg from horizontal
- Type III: > 50 deg from horizontal (most unstable with highest risk of nonunion/AVN).
3. Anatomical location, types:
- Subcapital: femoral head/neck junction (intracapsular fracture). Severity of a subcapital fracture is graded by the Garden classification of hip fractures.
- Transcervical: midportion of femoral neck (intracapsular fracture)
- Basicervical: base of femoral neck ( extracapsular fracture).
References[edit | edit source]
- Garden RS. Low-angle fixation in fractures of the femoral neck. The Journal of Bone and Joint Surgery. British Volume. 1961 Nov;43(4):647-63.
- Florschutz AV, Langford JR, Haidukewych GJ, Koval KJ. Femoral neck fractures: current management. Journal of orthopaedic trauma. 2015 Mar 1;29(3):121-9.
- Radiopedia Classification Garden Available: https://radiopaedia.org/articles/garden-classification-of-hip-fractures?lang=gb(accessed 13.12.2022)
- Orthobullets Femoral neck fractures Available;https://www.orthobullets.com/trauma/1037/femoral-neck-fractures (accessed 16.12.2022)
- Radiopedia NOF fracture Available:https://radiopaedia.org/articles/neck-of-femur-fracture-1?lang=us (accessed 16.12.2022)