MANUAL MINORS
The Garden classification is used to describe and categorise femoral neck fractures, primarily intracapsular fractures. It is crucial for determining the prognosis and management of these fractures, as the blood supply to the femoral head may be compromised, increasing the risk of avascular necrosis. The classification is divided into four types, ranging from minimal to severe fracture displacement.
Diagnosis
The diagnosis of a femoral neck fracture is made through clinical evaluation, often presenting with groin pain and functional limitation in the patient, usually associated with a fall or trauma mechanism. Anteroposterior and lateral hip X-rays are essential for assessing and classifying the fracture according to Garden:
Garden I: Incomplete or valgus-impacted fracture.
Garden II: Complete fracture without displacement.
Garden III: Complete fracture with partial displacement.
Garden IV: Complete fracture with total displacement, where the femoral head loses contact with the neck.
Differential Diagnosis
Condition | Key Differentiation |
|---|---|
Intertrochanteric fracture | Affects the region between the greater and lesser trochanters, outside the joint capsule |
Avascular necrosis of the femoral head | Not associated with direct trauma; presents chronically |
Hip dislocation | No fracture, but there is a loss of joint congruence |
Severe osteoarthritis | Chronic pain without a traumatic history, with degenerative changes on X-ray |
Emergency Management
Initial management of femoral neck fractures includes stabilising the patient, providing adequate pain relief (often with opioids or nerve blocks), immobilising the affected limb, and urgent surgical planning. Haemodynamic stability should be monitored, especially in elderly patients with comorbidities.
Definitive Treatment
Definitive treatment depends on the Garden classification. For Garden types I and II fractures, internal fixation with cannulated screws is typically the treatment of choice. In Garden III and IV fractures, especially in older patients or those with comorbidities, partial or total hip arthroplasty is preferred due to the high risk of avascular necrosis and non-union.
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