A trochanteric fracture is a fracture involving the greater and/or lesser trochanters of the femur.
Classification
Fractures in these regions can be classified as:
pertrochanteric: intertrochanteric, involving both trochanters
Inter-trochanteric fracture
They are subdivided according to the number of fragments, as follows:
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 the subtrochanteric component
type IV: oblique fracture of the shaft with extension into the subtrochanteric region
The Tronzo classification is another classification system
type I: incomplete fracture
type II: no posteromedial comminution, lesser trochanter may be fractured
type III: posteromedial comminution, the shaft is medially displaced with the neck beak impacted into it
type III variant: type III combined with greater trochanter fracture
type IV: posteromedial comminution, the shaft is laterally displaced
type V: reverse obliquity
Subtrochanteric 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.
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type I: short oblique
linear
comminuted
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type II: long oblique
linear
comminuted
-
type III: transverse
high level
low level
Treatment and prognosis
Sub-trochanteric fractures generally have a good prognosis due to the good supply of blood and adequate collateral circulation to this region of the femur with a low incidence of avascular necrosis and non-union. Post-operative infection, however, is a potentially serious complication.
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