Intertrochanteric Fracture

Evans Classification

• In stable fracture patterns, the posteromedial cortex remains intact or has minimal comminution, making it possible to obtain a stable reduction.

• Unstable fracture patterns are characterized by greater comminution of the posteromedial cortex.

• The reverse obliquity pattern is inherently unstable because of the tendency for medial displacement of the femoral shaft.

Orthopaedic Trauma Association (OTA) Alphanumeric Fracture Classification

• 31-A Femur, proximal trochanteric

• 31-A1 Peritrochanteric simple

• 31-A1.1Along intertrochanteric line

• 31-A1.2Through greater trochanter

• 31-A1.3Below lesser trochanter

• 31-A2 Peritrochanteric multifragmentary

• 31-A2.1With one intermediate fragment

• 31-A2.2With several intermediate fragments

• 31-A2.3Extending more than 1 cm below lesser trochanter

• 31-A3 Intertrochanteric• 31-A3.1Simple oblique• 31-A3.2Simple transverse• 31-A3.3Multifragmentary

Orthopaedic Trauma Association (OTA) Alphanumeric Fracture Classification

Subtrochanteric Fractures

Fielding classification

• The Fielding classification is a pure anatomical classification describing the position of the major fracture line with respect to the lesser trochanter

Seinsheimer classification• The Seinsheimer classification

takes into account the factors affecting the stability of the fractures. It introduces the concept of the posteromedial cortical support, which has a direct effect on the stability.

• It also indicates that the more distal the primary fracture line is, the higher the incidence of complications will be.

• This classification offers guidelines for management and prognosis

Russell-Taylor classification

• The Russell-Taylor classification (I and II with A and B subgroups) is based on the integrity of the piriformis fossa, which the author has advocated as the entry point to the femoral medullary canal.

• This classification also takes into consideration the involvement of the greater and lesser trochanters in the fractures.

• Although it serves as a guideline for a special technique in intramedullary nailing, the integrity of the piriformis fossa to nailing may not be as important as it used to be, due to a better understanding of the entry point anatomy and availability of implants with improved designs

AO classification of subtrochanteric fractures

• The AO classification is a descriptive classification based on the fracture configuration.

• The subtrochanteric fracture belongs to the group of femoral diaphyseal fracture 32-(X-#)-1. (X) is the subclassification of the fracture patterns, and these patterns are subclassified into a, b, and c subgroups.

• Subgroup a is simple fracture, group b is wedge fracture, and c represents complex fractures. The numeric description # indicates the degree of comminution