Garden's classification

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This is used in the diagnosis and management of neck of femur fractures. It is a four stage classification based on the appearance on the AP radiograph. It relies on the alignment of the trabeculae of the femur and the acetabulum.

The relevance is that the higher the Garden stage then the more likely it is that the blood supply to the femoral head is disrupted. The implication being that the patient is less likely to benefit from simple fixation of the fracture and more likely to require a replacement procedure (e.g. Hemiarthroplasty, Total hip replacement).


Stage I

Partial fracture or impaction.

The trabeculae are malaligned as the part of the bone remains in continuity and acts to lever the head around.

Stage II

Complete fracture with no displacement.

Trabeculae are in alignment in the presence of a fracture because there is no force to move the head around

Stage III

Complete fracture with some displacement.

Trabeculae are not aligned as retinacular fibres remain in continuity and act to turn the femoral head.

Stage IV

Complete fracture with total displacement.

The trabeculae are once again aligned as the head and neck of femur are now totally seperate and the head is free to return to its correct position.