Question
An 83 year old woman who lives independently and walks without aids falls at home. She cannot weight bear on her left leg.
- Describe the radiograph and classify the fracture.
- What treatment would you offer and why?
- What are the standards of care?
Answer
Radiograph
- Displaced subcapital fracture of the left femoral neck
- Garden IV (Garden III and IV are grouped as displaced)
- Pauwels angle describes the fracture line in younger patients
Garden classification
| Type | Description |
|---|---|
| I | Incomplete or valgus impacted |
| II | Complete, undisplaced |
| III | Complete, partly displaced |
| IV | Complete, fully displaced |
Treatment
- Arthroplasty, fixation of displaced fractures in the elderly fails often
- Total hip arthroplasty for independent, cognitively intact patients
- HEALTH trial showed small functional gains with THA and more dislocation
- Hemiarthroplasty for less active or cognitively impaired patients
- Cemented stems reduce periprosthetic fracture and pain (WHiTE 5)
- Anterolateral approach lowers dislocation risk
ANZ Hip Fracture Care Standard
- Surgery within 48 hours
- Orthogeriatric care
- Nerve block (fascia iliaca) in the emergency department
- Delirium screening
- Weight bear as tolerated on day one
- Bone protection before discharge
Related pages
Author Contributions
Orthofracs team
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.