Classifications of Intertrochanteric fractures and their Clinical Importance

Introduction Intertrochanteric (IT) fractures are most common fractures seen in elderly osteoporotic, usually due to simple fall in the house. With increasing number of elderly patients its number is estimated to be double by 2040 [1]. Understanding important factors in management of IT fracture like stability, reduction, role of posteriomedial wall, lateral wall, will help in choosing implant for better outcome. Most classifications are based on these factors and help in selecting management protocols. Many classification systems have come from last 6 decades, but none of them are found to be unanimously acceptable worldwide. Few classifications have focussed on stability and anatomical pattern (Evans; Ramadier; Decoulx; & Lavarde) while others on maintaining reduction of various types (Jensen's modification of Evan's, Ender; Tronzo, AO). An ideal classification should be simple, reproducible, easy to apply and should provide information on stability after reduction, secondary displacement, technique of fixation, postoperative mobilisation, outcome, and also data organisation for research. It should have good interrater and intrarater reliability and validity. Classification Review: Various classifications in Intertrochanteric fractures: Evans Classification [2] (Fig 1): In 1949, Evans published his classification on intertrochanteric (IT) fractures as follows: Type I: Stable: -Undisplaced fractures. -Displaced but after reduction overlap of the medial cortical buttress make the fracture stable. Unstable: -Displaced and the medial cortical buttress is not restored by reduction of fracture. -Displaced and comminuted fractures in which the medial cortical buttress is not restored by reduction of the fracture. Type II: Reverse obliquity fractures.