Cooke and Newman’s classification of periprosthetic hip fractures is a modification of the Bethea classification based on the level of the fracture in relation to the prosthesis. There are several types of fracture managing methods for classifying, investigating the fracture pattern, severity, degree, location, type, angulation, shortening – lengthening, comminution, rotation, displacement, the status of the femoral implant, the quality of surrounding femoral soft tissue injury and fracture angle are universally and widely accepted by orthopedic surgeons to assess the initial injury, plan management, and predict prognosis, to manage decision making, in determining whether a fracture requires an intramedullary nail or open reduction with internal fixation with steel screws, rods, plates, pins, or K-wires to hold the broken bones in the correct position even external fixation attaches a metal framework outside the limb and includes the Ilizarov method and an X-frame.
The Cooke and Newman classification of periprosthetic hip fractures is a modified classification of the Bethea classification proposed several years earlier.
- type I
- explosion type fracture, comminuted around the stem of the implant
- the prosthesis is always loose and the fracture is inherently unstable
- type II
- oblique fractures around the stem
- fracture pattern is stable, but prosthetic loosening is usually present
- type III
- transverse fracture at the level of the tip of the stem
- the fracture is unstable, but the prosthetic fixation is usually unaffected
- type IV
- fracture distal to the implant
- the fracture is unstable, but the prosthetic fixation is usually unaffected
The Vancouver classification of periprosthetic hip fractures proposed by Duncan and Masri is the most widely accepted classification system. It helps to diagnose the fracture site, the status of the femoral implant, and the quality of surrounding femoral bone stock.
- type A: fractures involve the trochanteric area
- A(G): greater trochanter
- A(L): lesser trochanter
- type B: around the stem or just below it
- B1: stem stable
- B2: stem loose
- B3: stem loose, bone stock inadequate
- type C: well below the stem
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