Garden described different stages for an intracapsular fracture of the proximal femur (fracture of the femoral neck).
Radiologic examination: AP view of the pelvis and proximal femur, paying attention to the alignment of the medial weight-bearing lamellae (trabeculae) in the pelvis, femoral head and femoral neck.
Description
Medial Weight Bearing Lamellae
Term
Stage
greenstick fracture of the inferior cortical buttress with rotation, with X-ray appearance of impaction
femoral head lamellae rotated laterally
incomplete subcapital
I
complete fracture without tilting of the femoral head
aligned in pelvis, femoral head and femoral neck
complete subcapital
II
femoral head tilts but the posterior retinacular attachment between femoral fragments are intact
femoral head lamellae rotated medially
complete subcapital with partial displacement
III
complete separation of femoral head from the distal elements, with femoral head returning to a more "normal" position
aligned in pelvis and femoral head but not in femoral neck
complete subcapital with full displacement
IV
At any stage there is some risk of progression to the next higher stage if no intervention is taken.
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