Neck of femur fracture classification: Difference between revisions

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Latest revision as of 22:55, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]

Overview

There are multiple classifications available for neck of femur fracture. The most common classification systems for neck of femur fracture include Anatomical, Garden's, Pauwel's and AO/OTA classification.

Classification

There are multiple classifications available for neck of femur fracture. The most common classification systems for neck of femur fracture include Anatomical, Garden's, Pauwel's and AO/OTA classification.^[1]^[2]

Anatomical Classification

Anatomical classification is the commonly used classification for eck of femur fracture.^[3]^[4]

Schatzker Classification
Type I	Supcapital fracture
Type II	Transcervical fracture
Type III	Basicervical fracture

Garden's Classification

Garden's classification of neck of femur fracture is most commonly used classification.^[5]
It is based on anterioposterior (AP) radiographs and does not consider lateral or sagittal plane alignment.

Garden's Classification
Type I	Incomplete, valgus impacted fracture
Type II	Complete, nondisplaced fracture
Type III	Complete, partially displaced fracture
Type IV	Complete, fully displaced fracture

Pauwel's Classification

Pauwel's classified for neck of femur fracture is based on vertical orientation of fracture line.^[6]
Pauwel's angle is defined as the angle formed between the line of a fracture of the neck of the femur and the horizontal on an anterioposterior radiograph.
The greater the angle, the more unstable the fracture and thus worse the prognosis.

Pauwel's Classification
Type I	< 30 degree from horizontal
Type II	30 to 50 degree from horizontal
Type III	> 50 degree from horizontal

OTA System

AO/ASIF classification is also a widely accepted classification.^[7]
Proximal femur is given the number 31 based on the classification.
It is further subdivided as:

OTA System
A	Femoral Trochanteric fractures
	A1	Simple peritrochanteric
	A2	Multifragmentary peritrochanteric, lateral wall incompetent (< 20.5 mm)
	A3	Intertrochanteric (reverse obliquity)
B	Femoral Neck fractures
	B1	Subcapital
	B2	Transcervical
	B3	Basicervical
C	Femoral Head fractures
	C1	Split fracture
	C2	Depression fracture

References

↑ Rockwood, Charles (2010). Rockwood and Green's fractures in adults. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 9781605476773.
↑ Azar, Frederick (2017). Campbell's operative orthopaedics. Philadelphia, PA: Elsevier. ISBN 9780323374620.
↑ Rockwood, Charles (2010). Rockwood and Green's fractures in adults. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 9781605476773.
↑ Azar, Frederick (2017). Campbell's operative orthopaedics. Philadelphia, PA: Elsevier. ISBN 9780323374620.
↑ Garden RS. Low-angle fixation in fractures of the femoral neck. J Bone Joint Surg Br 1961;43-B:647-63.
↑ Pauwels F. Der Schenkelhalsbruch, ein mechanisches problem. Stuttgart: F. Enke; 1935.
↑ ME Muller, S Nazarian, P Koch. Classification AO des fractures. 1 Les os longs. Springler-Verlag, Berlin, 1987.

Template:WH Template:WS

[1] Rockwood, Charles (2010). Rockwood and Green's fractures in adults. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 9781605476773.

[2] Azar, Frederick (2017). Campbell's operative orthopaedics. Philadelphia, PA: Elsevier. ISBN 9780323374620.

[3] Rockwood, Charles (2010). Rockwood and Green's fractures in adults. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 9781605476773.

[4] Azar, Frederick (2017). Campbell's operative orthopaedics. Philadelphia, PA: Elsevier. ISBN 9780323374620.

[5] Garden RS. Low-angle fixation in fractures of the femoral neck. J Bone Joint Surg Br 1961;43-B:647-63.

[6] Pauwels F. Der Schenkelhalsbruch, ein mechanisches problem. Stuttgart: F. Enke; 1935.

[7] ME Muller, S Nazarian, P Koch. Classification AO des fractures. 1 Les os longs. Springler-Verlag, Berlin, 1987.

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@@ Line 1: / Line 1: @@
- __NOTOC__
+__NOTOC__
 {{Neck of femur fracture}}
@@ Line 5: / Line 5: @@
 ==Overview==
-There are multiple [[Classification|classifications]] available for neck of femur fracture. The most common classification systems for neck of femur fracture include Anatomical, Garden's, Pauwel's and AO/OTA [[classification]].
+There are multiple [[Classification|classifications]] available for neck of femur fracture. The most common classification systems for neck of [[femur fracture]] include Anatomical, Garden's, Pauwel's and AO/OTA [[classification]].
 ==Classification==
@@ Line 16: / Line 16: @@
 |}
-*Anatomical classification is the commonly used classification for Neck of femur fracture.<ref>{{cite book | last = Rockwood | first = Charles | title = Rockwood and Green's fractures in adults | publisher = Wolters Kluwer Health/Lippincott Williams & Wilkins | location = Philadelphia, PA | year = 2010 | isbn = 9781605476773 }}</ref><ref>{{cite book | last = Azar | first = Frederick | title = Campbell's operative orthopaedics | publisher = Elsevier | location = Philadelphia, PA | year = 2017 | isbn = 9780323374620 }}</ref>
+*Anatomical classification is the commonly used classification for eck of femur fracture.<ref>{{cite book | last = Rockwood | first = Charles | title = Rockwood and Green's fractures in adults | publisher = Wolters Kluwer Health/Lippincott Williams & Wilkins | location = Philadelphia, PA | year = 2010 | isbn = 9781605476773 }}</ref><ref>{{cite book | last = Azar | first = Frederick | title = Campbell's operative orthopaedics | publisher = Elsevier | location = Philadelphia, PA | year = 2017 | isbn = 9780323374620 }}</ref>
 {| class="wikitable"
@@ Line 22: / Line 22: @@
 |-
 | style="background: #4479BA; color: #FFFFFF; text-align: center;" |Type I
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |Lateral split [[Bone fracture|fracture]]
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Supcapital [[Bone fracture|fracture]]
 |-
 | style="background: #4479BA; color: #FFFFFF; text-align: center;" | Type II
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |Lateral Split-depressed [[Bone fracture|fracture]]
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Transcervical [[Bone fracture|fracture]]
 |-
 | style="background: #4479BA; color: #FFFFFF; text-align: center;" |Type III
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |Lateral Pure depression [[Bone fracture|fracture]]
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Basicervical [[Bone fracture|fracture]]
-|-
-| style="background: #4479BA; color: #FFFFFF; text-align: center;" |Type IV
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |Medial plateau [[Bone fracture|fracture]]
-|-
-| style="background: #4479BA; color: #FFFFFF; text-align: center;" |Type V
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |Bicondylar [[Bone fracture|fracture]]
-|-
-| style="background: #4479BA; color: #FFFFFF; text-align: center;" |Type VI
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |Metaphyseal-diaphyseal [[Dissociation (chemistry)|dissociation]]
 |}
 ===Garden's Classification===
-* Garden's [[classification]] of neck of femur fracture is most commonly used [[classification]].<ref> Garden RS. Low-angle fixation in fractures of the femoral neck. J Bone Joint Surg Br 1961;43-B:647-63. </ref>
+* Garden's [[classification]] of neck of femur fracture is most commonly used [[classification]].<ref>Garden RS. Low-angle fixation in fractures of the femoral neck. J Bone Joint Surg Br 1961;43-B:647-63. </ref>
+* It is based on anterioposterior (AP) radiographs and does not consider lateral or sagittal plane alignment.
 {| class="wikitable"
@@ Line 47: / Line 39: @@
 |-
 | style="background: #4479BA; color: #FFFFFF; text-align: center;" |Type I
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |Coronal split [[fracture]]
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Incomplete, valgus impacted [[fracture]]
 |-
 | style="background: #4479BA; color: #FFFFFF; text-align: center;" |Type II
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |Entire condylar [[Bone fracture|fracture]]
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Complete, nondisplaced [[Bone fracture|fracture]]
 |-
 | style="background: #4479BA; color: #FFFFFF; text-align: center;" |Type III
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |Rim avulsion [[Bone fracture|fracture]] of lateral plateau
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Complete, partially displaced [[Bone fracture|fracture]]
 |-
 | style="background: #4479BA; color: #FFFFFF; text-align: center;" |Type IV
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |Rim compression [[Bone fracture|fracture]]
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Complete, fully displaced [[Bone fracture|fracture]]
-|-
-| style="background: #4479BA; color: #FFFFFF; text-align: center;" |Type V
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |Four-part [[Bone fracture|fracture]]
 |}
 ===Pauwel's Classification===
-* Pauwel's [[Classification|classified]] for neck of femur fracture is based on vertical orientation of fracture line.<ref>Pauwels F. Der Schenkelhalsbruch, ein mechanisches problem. Stuttgart: F. Enke; 1935.</ref>
+* Pauwel's [[Classification|classified]] for neck of femur fracture is based on vertical orientation of [[fracture]] line.<ref>Pauwels F. Der Schenkelhalsbruch, ein mechanisches problem. Stuttgart: F. Enke; 1935.</ref>
-* Pauwel's angle is defined as the angle formed between the line of a fracture of the neck of the femur and the horizontal on an anterioposterior radiograph.
+* Pauwel's angle is defined as the angle formed between the line of a [[fracture]] of the [[neck of the femur]] and the horizontal on an anterioposterior [[Radiography|radiograph]].
-* The greater the angle, the more unstable the fracture and thus worse the prognosis.
+* The greater the angle, the more unstable the [[fracture]] and thus worse the [[prognosis]].
 {| class="wikitable"
 ! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pauwel's Classification
 |-
-| style="background: #4479BA; color: #FFFFFF; text-align: center;" |Zero-column fracture
+| style="background: #4479BA; color: #FFFFFF; text-align: center;" |Type I
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |Pure articular depression
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |< 30 degree from horizontal
 |-
-| style="background: #4479BA; color: #FFFFFF; text-align: center;" |1 Column fracture
+| style="background: #4479BA; color: #FFFFFF; text-align: center;" |Type II
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |Lateral column [[Bone fracture|fracture]]
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |30 to 50 degree from horizontal
 |-
-| style="background: #4479BA; color: #FFFFFF; text-align: center;" |2 Column fracture
+| style="background: #4479BA; color: #FFFFFF; text-align: center;" |Type III
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |Lateral and posterior column [[Bone fracture|fracture]]
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |> 50 degree from horizontal
-|-
-| style="background: #4479BA; color: #FFFFFF; text-align: center;" |3 Column  fracture
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |Bicondylar [[Bone fracture|fracture]] dividing into three fragments
 |}
 ===OTA System===
@@ Line 91: / Line 77: @@
 |-
 | rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |A
-| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |Extra-articular [[Bone fracture|fractures]]
+| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Femoral]] [[Trochanteric fossa|Trochanteric]] [[Bone fracture|fractures]]
 |-
 | style="background: #4479BA; color: #FFFFFF; text-align: center;" |A1
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |Avulsion
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Simple peritrochanteric
 |-
 | style="background: #4479BA; color: #FFFFFF; text-align: center;" |A2
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |Metaphyseal simple
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Multifragmentary peritrochanteric, lateral wall incompetent (< 20.5 mm)
 |-
 | style="background: #4479BA; color: #FFFFFF; text-align: center;" |A3
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |Metaphyseal multifragmentary
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Intertrochanteric (reverse obliquity)
 |-
 | rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |B
-| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |Partial articular [[Bone fracture|fractures]]
+| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Femoral]] [[Neck]] [[Bone fracture|fractures]]
 |-
 | style="background: #4479BA; color: #FFFFFF; text-align: center;" |B1
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |Pure split
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Subcapital
 |-
 | style="background: #4479BA; color: #FFFFFF; text-align: center;" |B2
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |Pure depression
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Transcervical
 |-
 | style="background: #4479BA; color: #FFFFFF; text-align: center;" |B3
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |Split depression
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Basicervical
 |-
-| rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |C
+| rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |C
-| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |Complete articular [[Bone fracture|fractures]]
+| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Femoral]] [[Head]] [[Bone fracture|fractures]]
 |-
 | style="background: #4479BA; color: #FFFFFF; text-align: center;" |C1
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Articular]] simple + [[metaphyseal]] simple
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Split]] [[Fracture (bone)|fracture]]
 |-
 | style="background: #4479BA; color: #FFFFFF; text-align: center;" |C2
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Articular]] simple, [[metaphyseal]] multifragmentary
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Depression [[fracture]]
-|-
-| style="background: #4479BA; color: #FFFFFF; text-align: center;" |C3
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Articular]] multifragmentary
 |}
@@ Line 134: / Line 117: @@
 [[Category:Orthopedics]]
 [[Category:Orthopedic surgery]]
-[[Category:Primary care]]
 [[Category:Fractures]]
 [[Category:Up-To-Date]]