Garden Classification

Garden RS. Low-angle fixation in fractures of the femoral neck. Described the four-stage classification by displacement on the AP radiograph, with union rates in a series of 80 patients followed for at least 12 months (I 100%, II 100%, III 93%, IV 57%) — a small, dated cohort given here for historical context only.

Frandsen PA, Andersen E, Madsen F, Skjodt T. Garden’s classification of femoral neck fractures: an assessment of inter-observer variation. Eight observers classified the same 100 radiographs identically in only 22 cases; agreement was substantially better when the four stages were collapsed to undisplaced (I–II) versus displaced (III–IV), which is the grouping most current practice uses.

An undisplaced fracture is usually treated with internal fixation. A displaced fracture is usually treated with hemiarthroplasty or total hip arthroplasty in an older or lower-demand patient, or with reduction and internal fixation in a younger patient, per local orthopaedic protocol and shared decision-making — age, baseline mobility, comorbidities, and time since injury (osteonecrosis risk) all factor into that choice alongside the Garden group.