Identifying and classifying a Garden fracture depends on several factors, such as the location of the fracture, its nature, and the history of the patient’s injury. If there is a clear pattern in the injury, then it is possible to use it as a basis to diagnose the patient’s Garden classification. The study of this kind of fracture is a multidisciplinary effort that involves a team of doctors, including an orthopedic surgeon, a pathologist, a radiologist, an X-ray technologist, a physical therapist, and other health care professionals. Ultimately, a classification can be established that will provide a more accurate diagnosis, and allow the patient to receive the appropriate treatment.
A study was conducted to assess inter-observer reliability in three femoral neck fracture classification systems. The AO, Pauwels, and Garden classifications were evaluated. All three showed fair to good inter-observer reliability.
The AO classification showed the highest intra-observer reliability. It provides detailed pictograms of every specification to help raters in the decision making process. This was achieved through a number of modalities including X-ray images, a digital database, and a 3D-printed model.
The Pauwels classification showed moderate inter-observer reliability. A subgroup analysis showed a high reliability for the middle experienced group. However, this was not the case for the more experienced groups.
The AO/OTA simplified classification showed a similar reliability to the Garden. This was due to the fact that the classification system combines three FNF classifications. Nonetheless, this remains an unreliable system.
The 10-segment classification has been proclaimed to be more reliable than the Revisited Schatzker classification. This was due to the fact that the percentage match was high.
Reliability of the system
A reliable radiographic classification system is important to achieve accurate classification of pathology and to perform the correct treatment. It is also useful for determining surgical strategy. The Garden classification is one such radiographic classification system.
Many studies have evaluated the reliability of this classification. However, most of them were retrospective. They were limited by uncertainties in the definition of stable/unstable fractures. Also, the small sample size made it difficult to draw definite conclusions.
Some of the newer studies have sought to develop a classification that has high inter-observer and intra-observer agreement. These studies use kappa values and Landis and Koch’s proposed guidelines for the interpretation of such values.
One study used this classification to evaluate the reliability of the Pauwels classification. Several orthopaedic trauma surgeons participated in the analysis. Their experience was divided into three groups. Each group included two junior and two senior residents.
Location of the fracture in the femoral neck
Several classification systems have been used to classify femoral neck fractures. The most common classification system is the Garden classification. This classification is based on radiographic images. It has four basic types of fractures. Each type has its own subclassification.
Another commonly used classification system is the AO/OTA classification. It describes fractures from simple to multifragmentary. It has been criticized for its poor accuracy. However, this system is useful for clinical equipoise.
There are other fracture classification systems that are more precise and reproducible. They are most valuable when they are used to evaluate prognosis. Using anatomical information, three-dimensional imaging can detect rotational displacements. Using this approach, a reliable classification for femoral neck fractures can guide implant selection and treatment options.
One classification, Pauwels, divides hip fractures into displaced and non-displaced fractures. In this system, a displaced fracture is defined as a fracture in which the femoral head rotates back to anatomical position. A non-displaced fracture is characterized by minimal rotational displacement.
Major complications in patients with Garden I
The Garden classification for femoral neck fractures has four stages. This classification system rates femoral neck fractures based on their severity. Compared to other classification systems, the Garden classification has the highest inter-observer reliability. But it also lacks the ability to account for the location of the fracture within the femoral neck. Consequently, future studies will need to determine its feasibility.
A study from Texas A&M University examined the effect of the Garden classification on the occurrence of major complications. It used a set of strict experimental controls. Surgeon experience did not influence the results.
Five trauma surgeons reviewed 100 patients with femoral neck fractures. Those that were found to be in the first quartile were not diagnosed with a major complication. Those in the fourth quartile were diagnosed with a major complication at an increased rate. For example, the incidence of major complications in the fourth quartile was 16.7%, whereas in the first quartile it was 9.1%.