New Comprehensive Classification Systems for Peri-trochanteric Femur Fractures

Vol 3 | Issue 2 | Sep – Dec 2017 | page: 31-34 | Aditya K. Agrawal

Author: Aditya K. Agrawal [1].

[1]Dept of Orthopaedics, Dhiraj Hospital, SBKS MIRC, SumandeepVidyapeeth, Waghodia, Vadodara, Gujarat, 391760 India.

Address of Correspondence
Dr. Aditya K. Agrawal
Dept of Orthopaedics, Dhiraj Hospital,
SBKS MIRC, SumandeepVidyapeeth, Waghodia,
Vadodara, Gujarat, 391760 India.


Purpose: A classification is considered as good classification if it describes the particularregion of bone, type of fracture, personality of fracture in either planes and helps in selectionof implant and most importantly easy to understand by an orthopedic surgeon. Classification becomes more complicated when there is double region involvement with comminution,or distal fracture is in shaft leading to segmental fracture.
Materials and Methods: There are numerous classification systems available in the presentliterature for peri-trochanteric femur fractures. These include Evan’s, Tronzo, and Boyd andGriffin, OTA classifications for peri-trochanteric region, Seinsheimer’s and Fieldingclassifications for sub-trochanteric region. AO classification which is widely acceptedcritically defines peri-trochanteric, head and neck region of fracture femur.
Results: Drawbacks of existing classifications are that they are based on fractureconfiguration in sagittal plane only except Seinsheimer’s classification which is based oncoronal plane fracture morphology. Furthermore, double regions/ multiple regions arenot properly defined in these classification systems. If the proper classification system is not followed, it will lead to the selection of wrong implants which thereby leads to complications.
Discussion: Advantages of our new classification system are that it is easy to understand; allregions of peri-trochanteric femur are covered, and in the selection of proper implant.Hence, intra-operative complications can be avoided with proper pre-operative planning.
Conclusion: Thus, we hope that our new comprehensive classification of peri-trochantericfemur may help to solve the mysteries surrounding the understanding, classifying, and treating the fractures of peri-trochanteric femur.
Keywords: Classification, comprehensive, femur, fracture, peri-trochanteric.


1. Marks R. Hip fracture epidemiological trends, outcomes, and risk factors, 1970-2009. Int J Gen Med 2010;3:1-17.
2. Chang KP, Center JR, NguyenTV, Eisman JA. Incidence of hip and other osteoporotic fractures in elderly men andwomen: Dubbo osteoporosis epidemiology study. J Bone Miner Res 2004;19:532-6.
3. Saudan M, Lubbeke A, Sadowskil C, Riand N, Stern R, Hoffmeyer P,.“Per-trochanteric fractures: Is there an advantage to an intramedullary nail: A randomized prospective study of 206 patients comparing the dynamic hip screw and proximal femoral nail,”. JOrthopTrauma, 2002; 16,386-93.
4. Pajarinen J,Lindahl J, Michelsson O, Savolainen V, Hirvensalo E. Pertrochanteric femoralfractures treated with a dynamic hip screw or a proximal femoral nail. A randomised study comparing post-operative rehabilitation. J Bone Joint Surg Br 2005;87:76-81.
5. Baumgaertner MR, Curtin SL, Lindskog DM. Intramedullary versus extramedullary fixation for the treatment of intertrochanteric hip fractures. Clin OrthopRelat Res 1998;348:87-94.
6. DavisTR, Sher JL, Horsman A, Simpson M, Porter BB, Checketts RG. Intertrochanteric femoral fractures. Mechanical failure after internal fixation. J Bone Joint Surg Br 1990;72:26-31.
7. Adams C.I, Robinson C. M, Court-Brown C.M, and Mcqueen M.M. “Prospective randomized controlled trail of an intramedullary nail versus dynamic screw and plate for intertrochanteric fractures of the femur,.” JOrthopTrauma, 2001; 15, 394-400.
8. Gadegone WM, Salphale YS. Proximal femoral nail-an analysis of 100 cases of proximal femoral fractures with an average follow up of 1 year. IntOrthop 2007;31:403-8.
9. Ballal MS, Emms N,Thomas G. Proximal femoral nail failures in extracapsular fractures of the hip. JOrthopSurg (Hong Kong) 2008;16:146-9.
10. Flores LA, Harrington IJ, Heller M.The stability of intertrochanteric fractures treated with a sliding screw-plate. J BoneJoint Surg Br 1990;72:37-40.
11. Bridle S.H, Patel A.D, Bircher M,. (1991) “Fixation of intertrochantericfractures of the femur: A randomized prospective comparison of the gamma nail anddynamic hip screw,”.J Bone Joint Surg, 1991; 73,330-4.
12. Halder SC.The Gamma nail for peritrochanteric fractures. J Bone Joint Surg Br 1992;74:340-4.
13. Schipper IB, Steyerberg EW, Castelein RM, van der HeijdenFH, den Hoed PT, Kerver AJ, et al. Treatment of unstable trochanteric fractures.Randomised comparison of the gamma nail and the proximal femoral nail. J BoneJoint Surg Br 2004;86:86-94.
14. Morihara T, Arai Y,Tokugawa S, Fujita S, Chatani K, Kubo T. Proximal femoral nail for treatment oftrochanteric femoral fractures. J OrthopSurg (Hong Kong) 2007;15:273-7.

How to Cite this article:  Agrawal A. K. New Comprehensive Classification Systems for Peri-trochanteric Femur Fractures. Trauma International Sep-Dec 2017;3(2):31-34.

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