Classification of subtrochanteric femoral fractures
Introduction
When considering a particular bony injury, a clear definition of the anatomical site of the fracture is required. Having defined the area of bone involved, the fracture may be further classified into subdivisions. The ideal classification system should have a low inter- and intra-observer variation and been demonstrated to be of value in determining the choice of treatment and/or prognosis.2
There are numerous reports within the literature on subtrochanteric femoral fractures. However, there is no consensus from these studies or other areas of the orthopaedic literature as to the definition of what constitutes such a fracture. In addition, these reports have different methods of classifying subtrochanteric fractures. This study examines the previously used definitions of a subtrochanteric fracture and compares the different classification systems. From this, a definition of subtrochanteric fractures is suggested along with the most appropriate method of classifying this fracture.
Section snippets
Materials and methods
A MEDLINE search was made for all years up to January 2008 to retrieve all published papers on subtrochanteric fractures using the search terms ‘hip fractures’, ‘proximal femoral fractures’ and ‘femoral fractures’. The abstracts from all identified articles were reviewed. In addition, a search was made from one of the author's own personal library (MJP) of articles on the topic of hip fracture. Only articles written in the English language were considered. From these articles and the references
Literature review
Seventy-nine papers were identified that mentioned a method of classification of subtrochanteric fractures. Within these articles, 15 different methods of classifying subtrochanteric fractures were identified (Table 2). Most classification methods used a combination of the following fracture characteristics: the number of different fragments, the appearance of the fracture line (transverse, oblique or spiral), the level of the fracture line and the degree of displacement. Fractures were
Discussion
Whilst we would consider this review of different trials to be extensive, it cannot be considered to include all the reported studies. We are, however, confident that the most commonly used classification methods of subtrochanteric femoral fractures have been identified.
Of the 15 classification systems that we identified, eight defined what the subtrochanteric zone was by specifying both the proximal and distal margins. The consensus in five of those eight studies was that the lower border of
Conflict of interest
The authors declare that they have no conflict of interest in connection with this paper. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
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