Subcapital Femoral Fractures

Classification

Garden

Type DisplacementDescription
IUndisplaced
incomplete/ impaction with up to 10° abduction
IIcomplete, undisplaced
IIIDisplacedcomplete, displaced
IVcomplete, totally displaced (trabecular lines of head & acetabulum line up)
Garden Classification of Subcapital Femoral Neck Fractures
  • Undisplaced fractures have
    • 0-5% AVN
    • 5-8% nonunion
  • Displaced fracture (III & IV) have
    • 20-35% AVN
    • 9-35% nonunion
    • reoperation rate of 1/9 (11%) » 1/3 of the 1/3 that don’t unite
  • Timing & AVN (Massie 1974)
    • < 12 hrs 25% AVN
    • 13-24hrs 30%
    • 24-48 hrs 40%
    • after 1 week 100%