Fractures around the hip joint is a major health problem allaround the globe. It is associated with high morbidity, impaired survival andincreased likelihood of further hospital admissions.16,17 A studypublished by Cooper et al showed that an estimated hip fracture in people ofage 35 and above was 1.66 million in 1990 which is expected to increase to 3.94million in 2025 and 6.
26 million in 2050 across the world. They also showedthat Europe and Asia accounts for one third of all the hip fractures in oldwomen in the world presently, but the demographic changes will more than 50% ofthe elderly female hip fractures in Asia alone by 2050.18 JohnBuchwald, in 1923, said that we all enter this world under the brim of thepelvis but quit a few will leave through the neck of the femur. After almost acentury and with all the advances in medical science, the statement is not veryfar from reality.
Hip fractures behave differently in young than in oldwhere they are associated with higher morbidity and mortality. Abrahamsen et al showed that hip fractures areassociated with a high mortality rate in first year of life after the fractureranging from 8.4% – 36%. They showed that the initial risk was almost thedouble that for age matched control population and highlighted the need forsurgical interventions to reduce the risk.19 Fracturesaround the hip are mainly acetabular fractures, femoral head and neck fracturesand per trochanteric fractures.
Intertrochanteric femur fractures include all the fracturesoccurring in the area between the two trochanters and may involve the two. Bonein this reason is highly vascularised, extracapsular and and cancellous hencethe union after the fracture is rarely a problem. It comprises of approximatelyhalf of the hip fractures occurring in elderly population.20 The riskfactors include female gender, increase age, gait abnormalities, dementia andosteoporosis.21 CLASSIFICATION OF INTERTROCHANTERICFEMUR FRACTURES Intertrochanteric femur fractures have been classified bymany over the period of time.
Some of them are based on stability andanatomical pattern while others focus on maintaining stability. Evansclassified intertrochanteric femur fractures based on continuation ofposteromedial cortex later modified by Jensen which improved the predictabilityof possibility of achieving anatomical reduction and risk of secondary failure.22 While Boyd and Griffin classifiedit according to the ease of reduction.23 Muller and his colleaguesclassified proximal femur fractures according to an uniform alphanumericclassification system which was later adopted by AO/OTA in their FractureCompendium.
24 Thisclassification system has shown good reliability , very useful in recordkeeping, deciding management and for research purposes. According to OA/OTA intertrochanteric femur fractures are classified as – 31-A1Peritrochanteric simple – 31-A1.1 Alongintertrochanteric line 31-A1.2 Through greater trochanter 31-A1.3 Below lesser trochanter 31-A2Peritrochanteric multifragmentary – 31-A2.1With one intermediate fragment 31-A2.
2 With several intermediate fragments 31-A2.3Extending >1 cm below lesser trochanter 31-A3Intertrochanteric fractures – 31-A3.1 Simple oblique 31-A3.2 Simple transverse 31-A3.3Multifragmentary. Fractures A1.1 to A2.1 are considered stable fractures, whilefractures A2.2 to A3.3 are usually unstable.