The Garden classification is a system of categorizing intracapsular

hip fractures A hip fracture is a break that occurs in the upper part of the femur (thigh bone). Symptoms may include pain around the hip, particularly with movement, and shortening of the leg. Usually the person cannot walk. They most often occur as a res ...

of the

femoral neck The femoral neck (femur neck or neck of the femur) is a flattened pyramidal process of bone, connecting the femoral head with the femoral shaft, and forming with the latter a wide angle opening medialward. Structure The neck is flattened from ...

. This fracture often disrupt the blood supply to the

femoral head The femoral head (femur head or head of the femur) is the highest part of the thigh bone (femur). It is supported by the femoral neck. Structure The head is globular and forms rather more than a hemisphere, is directed upward, medialward, and a l ...

. British orthopaedic surgeon described a classification system for this type of fracture, referred to as the Garden classification and consisting of four grades:

Classification

Clinical relevance

The blood supply of the femoral head is much more likely to be disrupted in Garden types 3 or 4 fractures. Surgeons may treat these types of fracture by replacing the fractured bone with a prosthesis

arthroplasty Arthroplasty (literally " e-orming of joint") is an orthopedic surgical procedure where the articular surface of a musculoskeletal joint is replaced, remodeled, or realigned by osteotomy or some other procedure. It is an elective procedure that i ...

. Alternatively the treatment is to reduce the fracture (manipulate the fragments back into a good position) and fix them in place with metal screws. Common practice is to repair Garden 1 and 2 fractures with screws, and to replace Garden 3 and 4 fractures with arthroplasty, except in young patients in whom screw repair is attempted first, followed by arthroplasty if necessary.Akhtar M Khan
Fractures of the Lower Limb
/ref> This is done in an effort to conserve the natural joint since prosthetic joints ultimately wear out and have to be replaced. A serious but common complication of a fractured femoral neck is

avascular necrosis Avascular necrosis (AVN), also called osteonecrosis or bone infarction, is death of bone tissue due to interruption of the blood supply. Early on, there may be no symptoms. Gradually joint pain may develop which may limit the ability to move. Co ...

. The vasculature to the femoral head is easily disturbed during fractures or from swelling inside the joint capsule. This can lead to strangulation of the blood supply to the femoral head and death of the bone and cartilage.

References

{{reflist Hip fracture classifications