Trochanteric fracture

Dr Aditya Shetty et al.

Trochanteric fracture is a fracture involving the greater and/or lesser trochanters of the femur.

Classification

Fractures in these region can be classified as:

  • intertrochanteric
  • subtrochanteric
  • greater trochanteric avulsion fracture
  • lesser trochanteric avulsion fracture
Intertrochanteric fracture

They are subdivided as per number of fragments into:

  • two-part linear intertrochanteric fracture stable
  • three-part with comminution of lesser trochanter or greater trochanter
  • four-part with comminution of both trochanters
  • multi-part with comminution of both trochanters and intertrochanteric region

The Boyd and Griffin classification is based on the involvement of subtrochanteric region:

  • type I linear intertrochanteric
  • type II with comminution of trochanteric region
  • type III with comminution associated with subtrochanteric component
  • type IV oblique fracture of shaft with extension into subtrochanteric region
Subtrochonteric fracture

The Fielding classification of subtrochanteric fractures is based on the level of the subtrochanteric region through which the fracture extends:

  • type I: at the level of the lesser trochanter (most common)
  • type II: within the region 2.5 cm below the lesser trochanter
  • type III: within the region 2.5 cm to 5 cm below the lesser trochanter (least common)

The Zickel classification (modified from Fielding) of subtrochanteric fractures takes into consideration the level and obliquity of the fracture line as well as the presence or absence of comminution.

  • type I short oblique
    • linear
    • comminuted
  • type II long oblique
    • linear
    • comminuted
  • type III transverse
    • high level
    • low level

Treatment and prognosis

Subtrochanteric fractures generally have a good prognosis due to the good supply of blood and adequate collateral circulation to this region of the femur with low incidence of avascular necrosis and non-union. Postoperative infection, however, is a potentially serious compilation.


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Article Information

rID: 29734
Tags: shetty, refs
Synonyms or Alternate Spellings:
  • Boyd and Griffin classification
  • Fielding classification
  • Zickel classification

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Cases and Figures

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    Figure 1: Fielding Classification
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    Case 1: intertrochanteric
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    AP view
    Case 2: intertrochanteric
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    Subtrochanteric f...
    Case 3: subtrochanteric
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    Case 4: subtrochanteric
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    Cropped magnified...
    Case 5: greater trochanteric avulsion fracture
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    Case 6: Intertrochanteric fracture
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    Case 7: Intertrochanteric fracture
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