In neck of femur fractures, the Garden classification system divides fractures into four grades. Which grade represents a complete fracture with full displacement?

Explanation

## Garden Classification of Neck of Femur Fractures The Garden classification is based on the degree of displacement and angulation of the fracture fragment, assessed on anteroposterior and lateral radiographs. ### Classification System | Grade | Description | Displacement | Stability | Treatment | |-------|-------------|--------------|-----------|----------| | I | Incomplete (valgus) | Minimal | Stable | Conservative or ORIF | | II | Complete, non-displaced | No displacement | Stable | ORIF | | III | Complete, partially displaced | >50% displacement | Unstable | ORIF | | IV | Complete, fully displaced | 100% displacement | Unstable | ORIF or arthroplasty | **Key Point:** Grade IV represents complete fracture with full displacement, where the proximal fragment is completely separated and rotated. This is the most unstable type and carries the highest risk of avascular necrosis (AVN). **High-Yield:** Grades III and IV are considered unstable fractures and typically require operative intervention. Grade IV has the worst prognosis for union and highest AVN risk (up to 40–50%). **Clinical Pearl:** In elderly patients with Grade IV fractures, primary arthroplasty (hemiarthroplasty or total hip arthroplasty) is often preferred over ORIF due to poor bone quality and high AVN rates. **Mnemonic:** **GARDEN** = **G**rade I (incomplete), **A**ngulation minimal, **R**otation absent, **D**isplacement increases, **E**ach grade worse, **N**on-union risk rises.