Adult Subtrochanteric Femur Fractures

Type	Description
I	fracture is at the level of the lesser trochanter
II	fracture is 2.5 to 5 cm below the lesser trochanter
III	fracture is 5 to 7.5 cm below the lesser trochanter

Fielding’s Classification of Subtrochanteric Fractures

Transverse fractures fit this classification well, but oblique and comminuted fractures may involve more than one of the levels described

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

Seinsheimer classification of Subtrochanteric Fractures

Type	Description
I	fracture does not extend into piriformis fossa
Ia	comminution and fracture lines extend from below lesser trochanter to femoral isthmus
Ib	fracture lines and comminution involve area of lesser trochanter to isthmus
II	fracture extends proximally into greater trochanter and involves piriformis fossa
IIa	no significant comminution or fracture of lesser trochanter
IIb	significant comminution of medial femoral cortex and loss of continuity of lesser trochanter

Russell-Taylor classification of subtrochanteric fracture of femur

Treatment Recommendations Based on Russell-Taylor Classification of Subtrochanteric Fractures

Type	Fracture Description	Treatment
Ia	Piriformis fossa and lesser trochanter intact	Standard interlocking IM nail
Ib	Piriformis fossa intact, lesser trochanter fractured	Reconstruction IM nail
IIa	Piriformis fossa fractured, lesser trochanter intact	Hip screw or reconstruction IM nail
IIb	Piriformis fossa and lesser trochanter fractured	Hip screw with bone graft or reconstruction IM nail

Treatment Recommendations Based on Russel-Taylor Classification of Subtrochanteric Fractures