A new classification system for intertrochanteric fractures

Abstract

Trochanteric femoral fractures are among the most common injuries necessitating hospital admission and surgery is the mainstay of treatment. In order to appreciate the results, one needs to understand the fracture patterns involved. It is also important to know whether a fracture is stable or unstable: The answer to this question will guide the reduction technique, the type of fixation to be used, and the postoperative management. No classification is available till date that efficiently guides us for planning of treatment or helps us in prediction of potential complications. None of them has acceptable level of reproducibility. We developed a classification system based on four parameters namely 1. Condition of lateral wall 2. postero medial buttress 3. Extension of fracture line to femoral neck and 4. subtrochanteric extension. Five senior orthopaedic surgeons were asked to classify 30 sets of X-rays of standard AP and Lateral view of intra-trochanteric fractures based on the proposed classification system. The results were then analysed. We think the proposed classification system describes the fracture geometry efficiently, it gives a good idea about a fracture’s potential to be anatomically reduced. It also gives an insight towards various factors leading to instability and complications, which guides us in treatment planning, tell us about the possible potential complications. The classification system seems to have acceptable level of reproducibility.