Fractures neck fractures and per trochanteric fractures. Intertrochanteric

 

Fractures around the hip joint is a major health problem all
around the globe. It is associated with high morbidity, impaired survival and
increased likelihood of further hospital admissions.16,17 A study
published by Cooper et al showed that an estimated hip fracture in people of
age 35 and above was 1.66 million in 1990 which is expected to increase to 3.94
million in 2025 and 6.26 million in 2050 across the world. They also showed
that Europe and Asia accounts for one third of all the hip fractures in old
women in the world presently, but the demographic changes will more than 50% of
the elderly female hip fractures in Asia alone by 2050.18   

 

John
Buchwald, in 1923, said that we all enter this world under the brim of the
pelvis but quit a few will leave through the neck of the femur. After almost a
century and with all the advances in medical science, the statement is not very
far from reality. Hip fractures behave differently in young than in old
where they are associated with higher morbidity and mortality. Abrahamsen et al showed that hip fractures are
associated with a high mortality rate in first year of life after the fracture
ranging from 8.4% – 36%. They showed that the initial risk was almost the
double that for age matched control population and highlighted the need for
surgical interventions to reduce the risk.19   Fractures
around the hip are mainly acetabular fractures, femoral head and neck fractures
and per trochanteric fractures.

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Intertrochanteric femur fractures include all the fractures
occurring in the area between the two trochanters and may involve the two. Bone
in this reason is highly vascularised, extracapsular and and cancellous hence
the union after the fracture is rarely a problem. It comprises of approximately
half of the hip fractures occurring in elderly population.20 The risk
factors include female gender, increase age, gait abnormalities, dementia and
osteoporosis.21

 

 

 

 

 

CLASSIFICATION OF INTERTROCHANTERIC
FEMUR FRACTURES

                           

Intertrochanteric femur fractures have been classified by
many over the period of time. Some of them are based on stability and
anatomical pattern while others focus on maintaining stability. Evans
classified intertrochanteric femur fractures based on continuation of
posteromedial cortex later modified by Jensen which improved the predictability
of possibility of achieving anatomical reduction and risk of secondary failure.22
 While Boyd and Griffin classified
it according to the ease of reduction.23 Muller and his colleagues
classified proximal femur fractures according to an uniform alphanumeric
classification system which was later adopted by AO/OTA in their Fracture
Compendium.24  This
classification system has shown good reliability , very useful in record
keeping, deciding management and for research purposes.

                                    

                                        
According to OA/OTA intertrochanteric femur fractures are classified as –

 

31-A1
Peritrochanteric simple – 31-A1.1 Along
intertrochanteric line
                                                  
31-A1.2 Through greater trochanter
                                                   31-A1.3 Below lesser trochanter

 

31-A2
Peritrochanteric multifragmentary – 31-A2.1
With one intermediate fragment
                                                                    
31-A2.2 With several intermediate fragments
                 
                                                   31-A2.3
Extending >1 cm below lesser 
trochanter

 

31-A3
Intertrochanteric fractures – 31-A3.1 Simple oblique
                                                       
31-A3.2 Simple transverse
             
                                         31-A3.3
Multifragmentary.

 

Fractures A1.1 to A2.1 are considered stable fractures, while
fractures A2.2 to A3.3 are usually unstable.

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