Garden Klassifikation der medialen Schenkelhalsfrakturen

Anwendung

Mediale Schenkelhalsfrakturen
Anmerkung
Die wohl am häufigsten angewendete Klassifikation der medialen Schenkelhalsfraktur.

Stadium 1INCOMPLETE SUBCAPITAL FRACTURE.
The abducted or’ impacted’ injury in which the fracture of the inferior cortical buttress is greenstick in nature, and a minimal degree of lateral rotation of the distal upon the proximal fragment creates the radiological illusion of impaction. The medial lamellae of the internal weight-bearing system in the distal fragment lie in abduction as compared with those in the capital
fragment which, itself, is adducted. If unprotected, this fracture may at any time become complete.
Stadium 2COMPLETE SUBCAPITAL FRACTURE WITHOUT DISPLACEMENT.
The inferior cortical buttress has been broken, but no tilting of the capital fragment has taken place. As in the Stage I fracture, the closely opposed fragments in this complete fracture may succumb to lateral rotation forces and show the classical displacement of subcapital separation.”
Stadium 3
COMPLETE SUBCAPITAL FRACTURE WITH PARTIAL DISPLACEMENT.
The two fragments retain their posterior retinacular attachment, and crushing of the posterior cervical cortex has not yet taken place. Lateral rotation of the distal fragment therefore tilts the capital fragment into abduction and medial rotation as shown radiologically by the direction of the medial weight-bearing lamellae in the femoral head. If the tendency
for the limb to rotate laterally is not resisted by external or internal fixation, stripping of the retinacular attachments and crushing of the thin posterior cervical cortex will allow the full displacement of Stage IV to occur.
Stadium 4
COMPLETE SUBCAPITAL FRACTURE WITH FULL DISPLACEMENT.
This stage is reached when the retinacular hinge is detached from the posterior surface of the neck and collapse of the posterior cortical shell has taken place. The fragments are then divorced from each other, and the capital fragment at once returns to a more normal position in the acetabulum. Its medial weight-bearing lamellae are then seen radiologically to lie in alignment with their fellows in the pelvis.