Chang Shimin, Hu Sunjun, Du Shouchao, Wang Zhenhai, Tian Kewei, Sun Guixin, Wang Xin, Rui Yunfeng
Department of Orthopedic Surgery, Yangpu Hospital, Tongji University, Shanghai, 200090, P. R. China.
Department of Traumatic Orthopedic Surgery, Yantaishan Hospital, Yantai Shandong, 264001, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2022 Sep 15;36(9):1056-1063. doi: 10.7507/1002-1892.202204080.
To introduce a novel comprehensive classification for femoral intertrochanteric fractures, and to accommodate the clinical requirement for the world-wide outbreak of geriatric hip fractures and surgical operations.
On the basis of reviewing the history of classification of femoral intertrochanteric fractures and analyzing the advantages and disadvantages of AO/Orthopaedic Trauma Association (AO/OTA) classification in different periods, combined with the current situation of extensive preoperative CT scan and three-dimensional reconstruction and widespread use of intramedullary nail fixation in China, the "Elderly Hip Fracture" Research Group of the Reparative and Reconstructive Surgery Committee of the Chinese Rehabilitation Medical Association proposed a novel comprehensive classification for femoral intertrochanteric fractures, focusing on the structure of fracture stability reconstruction during internal fixation.
The novel comprehensive classification of femoral intertrochanteric fractures incorporates multiple indicators of fracture classification, including the orientation of the fracture line, the degree of fracture fragmentation, the lesser trochanteric bone fragment and its distal extension length (>2 cm), the posterior coronal bone fragment and its anterior extension width (involving the lateral cortex of the head and neck implant entry point), transverse fracture of the lateral and anterior wall and its relationship with the implant entry point in the head and neck, and whether the cortex of the anteromedial inferior corner can be directly reduced to contact, . The femoral intertrochanteric fractures are divided into 4 types (type A1 is simple two-part fractures, type A2 is characterized by lesser trochanter fragment and posterior coronal fractures, type A3 is reverse obliquity and transverse fractures, type A4 is medial comminution which lacks anteromedial cortex transmission of compression force), each of which is subdivided into 4 subtypes and further subdivide into finer subgroups. In a review of 550 trochanteric hip fracture cases by three-dimensional CT, type A1 accounted for 20.0%, type A2 for 62.5%, type A3 for 15.5%, and type A4 for 2.0%, respectively. For subtypes, A2.2 is with a "banana-like" posterior coronal fragment, A2.4 is with distal cortex extension >2 cm of the lesser trochanter and anterior cortical expansion of the posterior coronal fragment to the entry portal of head-neck implants, A3.4 is a primary pantrochanteric fracture, and A4.4 is a concomitant ipsilateral segmental fracture of the neck and trochanter region.
The novel comprehensive classification of femoral intertrochanteric fractures can describe the morphological characteristics of fractures in more detail, include more rare and complex types, provide more personalized subtype selection, and adapt to the clinical needs of both fractures and surgeries.
介绍一种新型的股骨转子间骨折综合分类方法，以适应全球老年髋部骨折爆发及外科手术的临床需求。
在回顾股骨转子间骨折分类历史并分析不同时期AO/骨科创伤协会（AO/OTA）分类优缺点的基础上，结合我国目前广泛开展的术前CT扫描及三维重建情况以及髓内钉固定的广泛应用，中国康复医学会修复重建外科专业委员会“老年髋部骨折”研究组提出了一种新型的股骨转子间骨折综合分类方法，重点关注内固定过程中骨折稳定性重建的结构。
新型股骨转子间骨折综合分类纳入了骨折分类的多个指标，包括骨折线方向、骨折粉碎程度、小转子骨块及其远端延伸长度（>2 cm）、后冠状骨块及其向前延伸宽度（累及头颈植入物入口点的外侧皮质）、外侧和前壁的横行骨折及其与头颈植入物入口点的关系，以及内下前角皮质能否直接复位接触等。股骨转子间骨折分为4型（A1型为简单两部分骨折，A2型以小转子骨块和后冠状骨折为特征，A3型为反向斜形和横行骨折，A4型为内侧粉碎且缺乏前内侧皮质压缩力传导），每型再细分为4个亚型，进一步细分为更微小的亚组。通过三维CT对550例转子间髋部骨折病例进行回顾分析，A1型占20.0%，A2型占62.5%，A3型占15.5%，A4型占2.0%。对于亚型，A2.2型有“香蕉样”后冠状骨块，A2.4型小转子远端皮质延伸>2 cm且后冠状骨块前皮质扩展至头颈植入物入口处，A3.4型为原发性全转子骨折，A4.4型为同侧颈和转子区节段性骨折合并。
新型股骨转子间骨折综合分类能够更详细地描述骨折的形态特征，纳入更多罕见和复杂类型，提供更具个性化的亚型选择，适应骨折及手术的临床需求。
