- See:
Garden Alignment Index:
- Garden I:
- incomplete or impacted fracture, in which the trabeculae of the inferior neck are still intact;
- femoral head is tilted in a posterolateral direction, causing vaglus angulation at the frx site;
-
non surgical treatment:
- some european authors advocate non operative treatment for these injuries, noting that the frx is incomplete and results
in spontaneous healing in over 80% of patients;
- the problem with this approach is that these fractures are often very painful, and that cannulated screw fixation
offers substantial and immediate pain relief;
- ref: Femur-neck abduction fractures.
P. Maquet.
Acta Orthop. Belg. Vol 38. 1972. p 688-396.
-
surgical treatment of garden I:
- no attempt is made to disimpact the fracture;
- fixation is performed w/
cannulated screws in situ;
- as an alternative consider use of multiple
pins
- larger implants, such as compression hip screws or other nail plate devices, may increase risk of disimpaction at surgery and are to be avoided;
- surgery can be performed on a fracture table or can be performed in the lateral position on a flouro table;
- if surgery is to be performed in the lateral position, then the lateral radiograph is obtained by flexing and externally
rotating the hip (frog leg lateral);
- note that it not uncommon to find that the fracture displaces into retroversion in the frog lateral position;
- this means that the guide pins need to be inserted prior to obtaining a lateral radiograph;
- ref: Articular penetration is more likely in Garden I fractures of the hip.
P Hernigou and P. Besnard.
JBJS. Vol 79-B. 1997. p 285-258.
-
complications:
-
AVN develops in 10-40% of these frxs w/ or w/o internal fixation;
- results from extreme valgus position, which causes kinking of lateral epiphyseal vessels & medial epiphyseal vessels in ligamentum teres as the head;
-
non union:
- as pointed out by Hammer 1992, only 1/83 pts w/ Garden I fractures, developed a non union;
- case example:
- in the next example, the pins were placed at the correct level but could have been angled more superiorly
inorder to engage the central portion of the femoral head;
- Garden II:
- complete frx w/o displacement (as opposed to
stress frx)
- wt bearing trabeculae are interrupted by a frx line across entire femoral neck;
- is distinguished from impacted frx by slight varus deformity (see:
alignment index);
- since Garden II fractures are not impacted, there is no bony stability, and hence displacement will occur unless it is internally fixed;
- treated w/
closed reduction & internal fixation w/ either
cannulated screws or
pins;
- risk of non union:
- as pointed out by Hammer 1992, all Garden 2 fractures w/ transverse frx line went on to heal,
where as 2/5 fractures w/ a vertical configuration went on to non union;
*** 
Three cancellous bone screws versus a screw-angle plate in the treatment of Garden I and II fractures of the femoral neck.
Non Union of Subcapital Femoral Neck Fractures.
AJ Hammer.
J. Orthop Trauma. Vol 6, No 1, p 73-77; 1992
Non-operative treatment of impacted femoral neck fractures. A prospective study of 170 cases.
Reduction and fixation of subcapital fractures of the femur.
Garden RS. Orthopedic Clinics of North America. Vol 5: 1974. 683.
- example of normal hip:
