The Hip: Preservation, Replacement and Revision

Garden III & IV Hip Frx



- See: Garden Alignment Index

- Garden III: ***
    - complete fracture with partial displacement;
    - "if it needs a reduction, then its a type III fracture;"
    - frequently there is shortening and external rotation of distal frag;
    - retinaculum of Weitbrecht remains attached to, & maintains continuity between, the proximal and distal fragments;
    - trabecular pattern of femoral head does not line up w/ those of acetabulum, demonstrating incomplete displacement between femoral fragments;
    - management:
         - closed reduction and cannulated screw fixation:
                - risk of non union:
                      - as pointed out by Hammer (1992), 3/17 Garden 3 frx w/ transverse configuration went on to non union, whereas 6/14 frx w/ vertical configuration went on to non union;
    - hemiarthroplasty



- Garden IV:
    - complete fracture w/ total displacement (some authors feel that the degree of displacement between Garden III and IV fractures is not significant);
    - no continuity between proximal and distal fragments;
    - femoral head assumes its normal position with in the acetabulum, and therefore the trabecular patterns of the acetabulum and the femoral head are aligned;
    - management:
         - closed reduction and cannulated screw fixation:
                - risk of non union:
                      - as pointed out by Hammer (1992), 0/3 Garden 4 frx w/ transverse configuration went on to non union, whereas 2/5 frx w/ vertical configuration went on to non union;
                - hemiarthroplasty



Nonunion of Subcapital Femoral Neck Fractures.

Garden grading of intracapsular fractures: meaningful or misleading?



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, September 13, 2012 8:30 pm