Intertrochanteric & subtrochanteric fracture classification

1. Intertrochanteric Fracture

2. Evans Classification

3. • 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.

4. 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

5. Orthopaedic Trauma Association
(OTA) Alphanumeric Fracture
Classification

6. Subtrochanteric Fractures

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

8. 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

9. Russell-Taylor classification

10. • 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

11. 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