Skip to main content
SpringerLink
Log in

Perception of Garden’s classification for femoral neck fractures: an international survey of 298 orthopaedic trauma surgeons

  • Technical Report
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

The Garden classification is the most popular femoral neck fracture classification system. We surveyed orthopaedic surgeons about their preferences for femoral neck fracture classification systems and their belief about their ability to discriminate between the four different Garden fracture types. A questionnaire was developed to examine surgeons’ training and experience and their preferences for classification of femoral neck fractures by consulting five orthopaedic surgeons in Canada and the United States, and the previous literature. The Garden classification was the preferred femoral neck fracture classification for 72% of all the surveyed surgeons (n=298). Only 39% of all the surveyed surgeons believed they were able to distinguish all four Garden fracture types. However, 96% of the surgeons felt they could differentiate between undisplaced (Garden I/II) and displaced (Garden III/IV) fractures. High variability in the surgeons’ perceptions of the Garden classification system provides a rationale for discontinuing the use of this system in daily practice.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Alberts KA, Jervaeus J (1990) Factors predisposing to healing complications after internal fixation of femoral neck fracture. A stepwise logistic regression analysis. Clin Orthop 257:129–133

    Google Scholar 

  2. Barnes R, Brown JT, Garden RS, Nicoll EA (1976) Subcapital fractures of the femur. A prospective review. J Bone Joint Surg Br 58:2–24

    PubMed  CAS  Google Scholar 

  3. Beimers L, Kreder HJ, Berry GK, Stephen DJ, Schemitsch EH, McKee MD, Jaglal S (2002) Subcapital hip fractures: the Garden classification should be replaced, not collapsed. Can J Surg 45:411–414

    PubMed  Google Scholar 

  4. Blundell CM, Parker MJ, Pryor GA, Hopkinson-Woolley J, Bhonsle SS (1998) Assessment of the AO classification of intracapsular fractures of the proximal femur. J Bone Joint Surg Br 80:679–683

    Article  PubMed  CAS  Google Scholar 

  5. Crawford HB (1969) Impacted femoral neck fractures. Clin Orthop 66:90–93

    PubMed  CAS  Google Scholar 

  6. De Boeck H (1994) Classification of hip fractures. Acta Orthop Belg 60(suppl 1):106–109

    PubMed  Google Scholar 

  7. Fielding JW, Wilson SA, Ratzan S (1974) A continuing end-result study of displaced intracapsular fractures of the neck of the femur treated with the Pugh nail. J Bone Joint Surg Am 56:1464–1472

    PubMed  CAS  Google Scholar 

  8. Frandsen PA, Andersen E, Madsen F, Skjodt T (1988) Garden’s classification of femoral neck fractures. An assessment of inter-observer variation. J Bone Joint Surg Br 70:588–590

    PubMed  CAS  Google Scholar 

  9. Frandsen PA, Frigaard F (1980) Fractura collis medialis. Klassifikation. Ugeskr Laeger 142:565–566

    PubMed  CAS  Google Scholar 

  10. Garden R (1961) Low-angle fixation in fractures of the femoral neck. J Bone Joint Surg Br 43:647–661

    Google Scholar 

  11. Massie WK (1973) Treatment of femoral neck fractures emphasizing long term follow-up observations on aseptic necrosis. Clin Orthop 92:16–62

    Article  PubMed  Google Scholar 

  12. McCabe J, O’Farrell D, O’Byrne J, O’Brien T (1994) Observer variation in the radiographic classification of femoral neck fractures. J Bone Joint Surg Br 76:120

    Google Scholar 

  13. Muller ME, Nazarian S, Koch P, Schatzker J (1990) The AO classification of fractures of long bones. Springer, Berlin Heidelberg New York

    Google Scholar 

  14. Nieminen S, Satokari K (1975) Classification of medial fractures of the femoral neck. Acta Orthop Scand 46:775–781

    PubMed  CAS  Google Scholar 

  15. Nieminen S, Satokari K (1975) Classification of medial fractures of the femoral neck. Ann Chir Gynaecol Fenn 64:369–374

    PubMed  CAS  Google Scholar 

  16. Nilsson LT, Johansson A, Stromqvist B (1993) Factors predicting healing complications in femoral neck fractures. 138 patients followed for 2 years. Acta Orthop Scand 64:175–177

    PubMed  CAS  Google Scholar 

  17. Parker MJ (1993) Garden grading of intracapsular fractures: meaningful or misleading? Injury 24:241–242

    Article  PubMed  CAS  Google Scholar 

  18. Parker MJ (1994) Prediction of fracture union after internal fixation of intracapsular femoral neck fractures. Injury 25(suppl 2):B3–B6

    PubMed  Google Scholar 

  19. Pauwels F (1935) Der Schenkelhalsbruch - ein mechanisches Problem: Grundlagen des Heilungsvorganges, Prognose und Therapie. Ferdinand Enke Verlag, Stuttgart

    Google Scholar 

  20. Scavenius M, Ibsen A, Ronnebech J, Aagaard H (1996) Inter- and intra observer variation in the assessment of femoral neck fractures according to the Garden classification. Acta Orthop Scand 67:29

    Article  Google Scholar 

  21. Thomsen NO, Jensen CM, Skovgaard N, Pedersen MS, Pallesen P, Soe-Nielsen NH, Rosenklint A (1996) Observer variation in the radiographic classification of fractures of the neck of the femur using Garden’s system. Int Orthop 20:326–329

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

This work was funded in part by a surgical research grant, McMaster University, a Regional Medical Associates Grant, McMaster University, and a Grant from AO North America, Paoli, Pennsylvania. These investigators are members of the International Hip Fracture Research Collaborative. For more information: http\\:www.ihfrc.ca.

Author information

Authors and Affiliations

  1. Department of Surgery, McMaster University, Hamilton, ON, Canada

    Michael Zlowodzki

  2. Department of Surgery, University of Zurich, Zurich, Switzerland

    Marius Keel

  3. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Emil Schemitsch

  4. Department of Surgery, AO Clinical Investigation and Documentation, Davos, Switzerland

    Beate P. Hanson

  5. Division of Orthopedic Surgery, Hamilton General Hospital, McMaster University Medical Center, 7 North, Suite 727, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada

    Mohit Bhandari

Authors
  1. Michael Zlowodzki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mohit Bhandari
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marius Keel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Beate P. Hanson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Emil Schemitsch
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mohit Bhandari.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zlowodzki, M., Bhandari, M., Keel, M. et al. Perception of Garden’s classification for femoral neck fractures: an international survey of 298 orthopaedic trauma surgeons. Arch Orthop Trauma Surg 125, 503–505 (2005). https://doi.org/10.1007/s00402-005-0022-4

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-005-0022-4

Keywords

Search

Navigation