Garden classification of hip fractures

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

  • 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) .

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