Friday, February 26, 2010

The Garden Classification

The Garden classification of femoral neck (subcapital) fractures is the most commonly used system and is based on the degree of displacement on the anteroposterior radiographs.
  • Stage I: Incomplete fracture (impacted valgus fracture).
  • Stage II: Complete fracture with minimal or no displacement from anatomically normal position.
  • Stage III: Complete fracture with partial displacement.
  • Stage IV: Complete fracture with full displacement.
Differentiation between nondisplaced (Garden I and II) and displaced (Garden III and IV) femoral neck fractures has therapeutic as well as prognostic value. Type I and II fractures have a low incidence of avscular necrosis and are usually treated by internal fixation using a dynamic hip screw. The high incidence of avascular necrosis in type III and IV fractures precludes internal fixation, and these fractures are often treated by arthroplasty.


  • Garden R. Low-angle fixation in fractures of the femoral neck. J Bone Joint Surg Br, 1961(43):647–661.
  • Zlowodzki M, Bhandari M, Keel M, Hanson BP, Schemitsch E. Perception of Garden's classification for femoral neck fractures: an international survey of 298 orthopaedic trauma surgeons. Arch Orthop Trauma Surg. 2005 Sep;125(7):503-5.

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