This document discusses different classification systems used for intertrochanteric and subtrochanteric hip fractures. It describes the Evans classification system which categorizes fractures as stable or unstable based on the integrity of the posteromedial cortex. The Orthopaedic Trauma Association classification system uses alphanumeric codes to further describe fracture patterns. For subtrochanteric fractures, the document outlines the Fielding, Seinsheimer, Russell-Taylor, and AO classification systems which take into account factors like the position of fracture lines, stability, and degree of comminution.

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