The document discusses classifications and treatment approaches for subtrochanteric fractures of the femur. It describes Fielding and Seinsheimer classifications which categorize fractures based on their location and number of fragments. Temporary options include a Thomas splint for unstable patients. Surgical treatments involve plates, intramedullary nails, or external fixators. Precise surgical approaches depend on the fracture location and stability. Potential complications are also noted.

1. Subtrochanteric fracture
Orthopaedic surgeon : Zagarzusem.E

7. Fielding classification
Subtrochanteric fractures is based
on the level of the subtrochanteric
region through which the fracture
extends.
• type I: at the level of the lesser
trochanter (most common)
• type II: within the region 2.5 cm
below the lesser trochanter
• type III: within the region 2.5 cm
to 5 cm below the lesser
trochanter (least common)

8. Seinsheimer’s classification
• Type I: Nondisplaced fracture or one with less than
• 2 mm of displacement
• Type II: Two-part fracture
• Type IIa: Transverse fracture
• Type IIb: Spiral configuration with the lesser trochanter
• attached to proximal fragment
• Type IIc: Spiral configuration with the lesser trochanter
• attached to distal fragment
• Type III: Three-part fracture
• Type IIIa: Three-part spiral configuration with the lesser
• trochanter a part of the third fragment
• Type IIIb: Three-part spiral configuration with the third
• part a butterfly fragment
• Type IV: Comminuted fracture with four or more
• Fragments
• Type V: Subtrochanteric - intertrochanteric configuration

9. Temporary Thomas splint
Indications
• Medically unfit for surgery
• Polytrauma, in extremis

10. External fixator (subtrochanteric)

11. Compression plating - DCS (subtrochanteric)

12. Compression plating - locking plate
(subtrochanteric)

13. preparation
• Abducted contralateral leg The patient is positioned supine with the
contralateral leg flexed and abducted.

14. Supine position without traction
• The patient is positioned supine
on a radiolucent table. The
pelvis may be elevated by a firm
cushion.

15. Bilateral traction
• The patient is positioned supine
with both legs in traction on a
traction table.

16. Lateral decubitus position
• The patient is positioned in
lateral decubitus with the
contralateral leg resting on the
fracture table.

17. Knee flexed 30°
• The patient is positioned supine
on a radiolucent table with the
knee in 30° flexion.

18. Approach
• Antegrade nailing approach
with piriformis entry point

26. Lateral approach
• he fascia lata is split
longitudinally and the vastus
lateralis muscle is elevated off of
the intermuscular septum.

27. • Skin incision

28. Opening the fascia lata
• The fascia lata is incised with a
scalpel and split with scissors
parallel to the skin incision,
along its fibers.
• The muscle fascia over the
vastus lateralis is exposed.

29. Separation of vastus lateralis from fascia lata
• In the next step, the vastus
lateralis is separated by blunt
dissection from the fascia lata.

30. • The vastus lateralis is now
retracted anteromedially.
• The muscle fascia investing the
vastus lateralis is incised about 1
cm anterior to the intermuscular
septum.

31. Mobilization of vastus lateralis from intermuscular
septum
• The muscle is detached from the
lateral intermuscular septum
and the linea aspera with a
periosteal elevator.

34. Minimally invasive ostheosynthesis approach
• They vary according to the
fracture location:
• proximal (segment 1)
• mid-shaft (segment 2)
• distal femur (segment 3)
sections.

35. MIO approach to the subtrochanteric region
Skin incision
• The lateral proximal incision
starts at the greater trochanter
and continues distally as far as
needed.

36. Opening the fascia lata

38. Treatment
• Stable fractures:
Close reduction with
DHS(Dynamic hip screw)

39. • Unstable fractures:
Close reduction
Gamma-nail(Small lever
arm)

41. • Subtrochanteric fracture of
femur without trauma in a
patient with a new onset
fracture. The figure shows a
subtrochanteric fracture in a 66-
yr-old woman with a history of 8
yr risedronate treatment.

42. Subtrochanteric
fractures are from the
base of the lesser
trochanter to 5 cm distal

43. Low Subtroch Fx’s
Most low subtrochanteric
fractures with an intact
piriformis fossa can be treated
with a 1st gen IM Nail

44. When piriformis fossa is not
involved and the lesser
trochanter is fractured, a 2nd
generation nail may be used

45. Nail or… Plate

47. Complications
• Varus/ procurvatum malunion
• Nonunion
• Malunion:
- Coxa varus
- Shortening
- Rotational deformity
- Fixation failure
- Failure of implant

48. D.S:Закр.подвертельный перелом правой бедренной кости со-
смещ
D.S: Closed subtrochanteric fracture of right femur

49. Do you have any question?

50. Thank you so much