Evidence brief
Low-angle Fixation in Fractures of the Femoral Neck
Garden I: Incomplete/impacted, valgus angulation
Garden II: Complete but undisplaced
Garden III: Complete, partially displaced, trabeculae don't align
Garden IV: Complete, fully displaced, trabeculae parallel
AVN risk increases with displacement grade
The Garden classification remains the standard for femoral neck fracture communication. Practically, fractures are often simplified to 'displaced' (Garden III/IV) vs 'undisplaced' (Garden I/II) as this drives treatment decisions.
Know Garden classification cold but also know its limitations - poor inter-observer reliability. In practice: undisplaced (I/II) = fixation; displaced (III/IV) = replacement in elderly. Discuss the trabecular alignment seen on AP radiograph.
Garden RS. Low-angle fixation in fractures of the femoral neck. J Bone Joint Surg Br. 1961;43-B:647-663.
Level IV
Case series or case reports