Neck of femur fracture classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]

Overview

There are multiple classifications available for neck of femur fracture. The most common classification systems for neck of femur fracture include Anatomical, Garden’s, Pauwel’s and AO/OTA classification.

Classification

There are multiple classifications available for neck of femur fracture. The most common classification systems for neck of femur fracture include Anatomical, Garden’s, Pauwel’s and AO/OTA classification.^[1]^[2]

Anatomical Classification

Anatomical classification is the commonly used classification for eck of femur fracture.^[3]^[4]

Schatzker Classification
Type I	Supcapital fracture
Type II	Transcervical fracture
Type III	Basicervical fracture

Garden’s Classification

Garden’s classification of neck of femur fracture is most commonly used classification.^[5]
It is based on anterioposterior (AP) radiographs and does not consider lateral or sagittal plane alignment.

Garden’s Classification
Type I	Incomplete, valgus impacted fracture
Type II	Complete, nondisplaced fracture
Type III	Complete, partially displaced fracture
Type IV	Complete, fully displaced fracture

Pauwel’s Classification

Pauwel’s classified for neck of femur fracture is based on vertical orientation of fracture line.^[6]
Pauwel’s angle is defined as the angle formed between the line of a fracture of the neck of the femur and the horizontal on an anterioposterior radiograph.
The greater the angle, the more unstable the fracture and thus worse the prognosis.

Pauwel’s Classification
Type I	< 30 degree from horizontal
Type II	30 to 50 degree from horizontal
Type III	> 50 degree from horizontal

OTA System

AO/ASIF classification is also a widely accepted classification.^[7]
Proximal femur is given the number 31 based on the classification.
It is further subdivided as:

OTA System
A	Femoral Trochanteric fractures
	A1	Simple peritrochanteric
	A2	Multifragmentary peritrochanteric, lateral wall incompetent (< 20.5 mm)
	A3	Intertrochanteric (reverse obliquity)
B	Femoral Neck fractures
	B1	Subcapital
	B2	Transcervical
	B3	Basicervical
C	Femoral Head fractures
	C1	Split fracture
	C2	Depression fracture

References

↑ Rockwood, Charles (2010). Rockwood and Green’s fractures in adults. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 9781605476773.
↑ Azar, Frederick (2017). Campbell’s operative orthopaedics. Philadelphia, PA: Elsevier. ISBN 9780323374620.
↑ Rockwood, Charles (2010). Rockwood and Green’s fractures in adults. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 9781605476773.
↑ Azar, Frederick (2017). Campbell’s operative orthopaedics. Philadelphia, PA: Elsevier. ISBN 9780323374620.
↑ Garden RS. Low-angle fixation in fractures of the femoral neck. J Bone Joint Surg Br 1961;43-B:647-63.
↑ Pauwels F. Der Schenkelhalsbruch, ein mechanisches problem. Stuttgart: F. Enke; 1935.
↑ ME Muller, S Nazarian, P Koch. Classification AO des fractures. 1 Les os longs. Springler-Verlag, Berlin, 1987.

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[1] Rockwood, Charles (2010). Rockwood and Green’s fractures in adults. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 9781605476773.

[2] Azar, Frederick (2017). Campbell’s operative orthopaedics. Philadelphia, PA: Elsevier. ISBN 9780323374620.

[3] Rockwood, Charles (2010). Rockwood and Green’s fractures in adults. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 9781605476773.

[4] Azar, Frederick (2017). Campbell’s operative orthopaedics. Philadelphia, PA: Elsevier. ISBN 9780323374620.

[5] Garden RS. Low-angle fixation in fractures of the femoral neck. J Bone Joint Surg Br 1961;43-B:647-63.

[6] Pauwels F. Der Schenkelhalsbruch, ein mechanisches problem. Stuttgart: F. Enke; 1935.

[7] ME Muller, S Nazarian, P Koch. Classification AO des fractures. 1 Les os longs. Springler-Verlag, Berlin, 1987.

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