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Garden Classification (Femoral Neck Fractures)

Garden (1961), types I-IV

Grades intracapsular femoral neck fractures I through IV on an AP radiograph by completeness and displacement, using the alignment of femoral head and acetabular trabeculae. The key clinical dichotomy is nondisplaced (I-II) versus displaced (III-IV).

Also searched as: hip · orthopedic · trauma · hip fracture · nof

Garden type

Assessed on a true AP hip radiograph from fracture completeness and trabecular alignment.

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  • Select the Garden type (I-IV) based on the AP hip radiograph.

How this tool works

Garden described four radiographic types in 1961: type I is an incomplete, valgus-impacted fracture; type II is complete but nondisplaced; type III is complete with partial displacement (head trabeculae malrotated relative to the acetabulum); and type IV is complete with full displacement, in which the head trabeculae realign with the acetabulum because the head fragment is detached. Displacement is what most often drives treatment, so modern practice frequently collapses the system into nondisplaced (types I and II) versus displaced (types III and IV). Displaced fractures carry substantially higher rates of avascular necrosis and nonunion, reflecting disruption of the femoral head blood supply; Garden reported union in essentially all type I-II fractures but progressively lower union for types III and IV.

References

Implemented from the cited published sources. Educational use only; confirm against current guidelines before clinical use.

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