Femoral Neck Fracture Classification and Treatment

Classification Systems

The American College of Radiology recommends a two-category approach for femoral neck fractures, distinguishing between non-displaced and displaced fractures, due to the poor interobserver reliability of the four-stage Garden classification system 1, 2
The AO Foundation/Orthopaedic Trauma Association classification is increasingly used, particularly with 3-D CT imaging, and has improved interobserver reliability when using CT compared to radiographs alone 1, 3

The American College of Radiology suggests that CT without contrast improves surgical decision-making and classification accuracy, altering surgical decisions in 21% of non-displaced femoral neck fractures 1, 3
CT is most valuable for measuring specific angles, such as the femoral neck impaction angle, which predicts secondary displacement with an odds ratio of 11.73 1, 3

The American Academy of Orthopaedic Surgeons recommends that the primary treatment-relevant distinction is displaced versus non-displaced fractures, with arthroplasty strongly recommended over fixation for displaced fractures 2, 4
For non-displaced fractures, internal fixation, hemiarthroplasty, or conservative care may be considered, depending on patient selection and specific fracture characteristics 2