Abstract
Aim: The purpose of this study was to assess the various subtrochanteric fracture classification systems particularly in relation to their predictive value for choice of treatment and outcome.
Methods: A comprehensive search of various data sources extending from 1966 to October 2003 was conducted to identify appropriate studies using specific search terms. Articles of all languages were considered. From these articles and those referenced within them, the use of, and any description of fracture classifications were recorded. Abstracts and studies reporting on less than ten fractures were excluded. A methodological scoring system adapted from that of Detsky was used to assess the quality of studies. For each classification system, features such as proximal and distal margin of subtrochanteric fractures, number of subdivisions, advice for fractures which cross the described anatomical boundaries, number of publications using that classification system, published articles showing value in predicting outcome and published articles showing inter-observer variation were analysed.
Results: 110 studies involving 2725 fractures were identified. 16 different classification methods were analysed. The actual length of femur defined as the subtrochanteric zone varied from 3 cms to12 cms. There was no agreement between the different classifications regarding the proximal and distal borders, or for classifying fractures that traverse anatomical boundaries. None of the classifications systems was shown to be of value in determining treatment or for predicting outcome.
Conclusion: There is a need for a universally accepted definition for subtrochanteric fractures and sub-classifying such fractures is questionable. Indicators to a simple yet valid classification system which takes into account the variations of this fracture and which would assist in determination of treatment and prediction of outcome are proposed.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
