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Subtrochanteric Femur Fractures

Classification

  • Between lesser trochanter & 5cm distally
  • Independent or as extension of IT fracture
  • Various classification systems – position & comminution

Russell-Taylor Classification

Russell Taylor Classification of Subtrochanteric Femoral Fractures
Type Description
IA lesser trochanter not involved
IB lesser trochanter involved
IIA extends into piriformis fossa, LT not involved
IIB extends into piriformis fossa, LT involved

DeLee (in Rockwood & Green) prefers concept of stable vs unstable

  • Stable:
    • possible to re-establish bone-bone contact of medial & posterior cortex with internal fixation device acting as tension band on lateral femoral cortex : impaction & weight bearing through the medial cortex
  • Unstable:
    • medial cortical apposition not possible due to comminution or fracture obliquity : lateral plate or IM device subjected to bending forces resulting in implant failure or loss of fixation