Adult Hip Fractures | Trauma
Subtrochanteric
Definition
Incidence
Aetiology
Anatomy
Classification
Fielding's Classification of Subtrochanteric 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 |
- Transverse fractures fit this classification well, but oblique and comminuted fractures may involve more than one of the levels described
Seinsheimer classification of Subtrochanteric Fractures
| 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 |
Russell-Taylor classification of subtrochanteric fracture of femur
- based on involvement of piriformis fossa
| 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 |
Pathology
History
Examination
Investigations
Xrays
Treatment
Nonoperative
Operative
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 |
Complications
Prognosis
Webpage Last Modified: 28 January, 2010