Femoral Neck Fractures

Garden (still the common language):

• I — incomplete / valgus impacted
• II — complete, nondisplaced
• III — complete, partially displaced
• IV — complete, fully displaced

In practice, many decisions collapse to nondisplaced vs displaced, plus patient physiology.

For the elderly patient:

• Nondisplaced / valgus impacted → often percutaneous fixation if medically ready
• Displaced → arthroplasty is frequently preferred (hemi vs total depends on activity, acetabulum, and surgeon/system factors)
• Young patient with displaced fracture → urgent anatomic reduction and fixation; this is a different disease

Medical optimization should be rapid, not endless. Hypotension, anemia, and missed second injuries still kill more patients than imperfect implant choice.

• Fixation: cannulated screws or sliding hip constructs per pattern and bone quality
• Arthroplasty: hemiarthroplasty vs THA — match to pre-injury function and acetabular wear
• VTE prophylaxis and early mobilization are part of the operation
• Watch for shortening / nonunion / AVN after fixation

• Garden classification language
• Displaced elderly → arthroplasty discussion
• Young displaced → urgent reduction and fixation
• Timing and medical co-management matter for mortality