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.

References

• 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.