American Academy of Orthopedic Surgeons Classification of Periprosthetic Hip Fractures

Dr. Harun Ar Rashid, MD - Arthritis, Bones, Joints Pain, Trauma, and Internal Medicine Specialist

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The American Academy of Orthopedic Surgeons classification of periprosthetic hip fractures divides the femur into three separate regions: level I: proximal femur distally to the lower extent of the lesser trochanter. level II: 10 cm of femur distal to level I. level III: femur distal to level II. 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 American Academy of Orthopedic Surgeons classification of periprosthetic hip fractures divides the femur into three separate regions:

level I: proximal femur distally to the lower extent of the lesser trochanter
level II: 10 cm of femur distal to level I
level III: femur distal to level II

Fractures are classified accordingly:

type I: fractures proximal to the intertrochanteric line; usually occur during dislocation of the hip
type II: vertical or spiral fractures that do not extend past lower extent of the lesser trochanter
type III: vertical or spiral fractures that extend past lower extent of lesser trochanter, but not beyond level II; usually at the junction of middle and distal thirds of the femoral stem
type IV: fractures that traverse femoral stem in level III or lie within that area
- type IV-A: spiral fractures around the tip of the stem
- type IV-B: simple transverse or short oblique fractures
type V: severely comminuted fractures around the stem in level III
type VI: fractures distal to the tip of the stem in level III

$American Academy of Orthopedic Surgeons classification (periprosthetic hip fracture)$


American Academy of Orthopedic Surgeons (AAOS) classification
Type I	fractures proximal to the intertrochanteric line; usually occur during dislocation of the hip
Type II	vertical or spiral fractures that do not extend past the lower extent of the lesser trochanter
Type III	vertical or spiral fractures that extend past the lower extent of the lesser trochanter, but not beyond level II; usually at the junction of middle and distal thirds of the femoral stem
Type IV	fractures that traverse femoral stem in level III or lie within that area type IV-A: spiral fractures around the tip of the stem type IV-B: simple transverse or short oblique fractures
Type V	severely comminuted fractures around the stem in level III
Type VI	fractures distal to the tip of the stem in level III

$American Academy of Orthopedic Surgeons classification (periprosthetic hip fracture)$

UCS Classification and periprosthetic fractures treatment algorithm.

JOINT	BONE
Shoulder Elbow Wrist Hip Knee Ankle	1: Humerus 14: Glenoid/scapula 2: Radius/ulna 3: Femur 4: Tibia 34: Patella 6: Acetabulum/pelvis 7: Carpus/metacarpals 8: Talus
FRACTURE TYPE	TREATMENT
A Apophyseal or extraarticular/periarticular Subtypes A1: Avulsion of (e.g. greater trochanter) A2: Avulsion of (e.g. lesser trochanter)	Depends on displacement and importance of soft tissue attached, e.g.: the greater trochanter, tibial tuberosity, greater humeral tuberosity: surgical treatment lesser trochanter, coracoid process: conservative treatment
B Bed of the implant or around the implant Subtypes B1: Prosthesis stable, good bone B2: Prosthesis loose, good bone B3: Prosthesis loose, poor bone or bone defect	B1: Lower limb: reduction and fixation, LCP, and if possible MIPO technique preferred. B1: Upper limb: depends on displacement, conservative treatment preferred. B2: Revision surgery. B3: Revision surgery that may require complex reconstruction (mega prosthesis, allograft/stem composite). Depends on the bone loss and age/activity of the patients.
C Clear of or distant to the implant	Same management as a no-periprosthetic fracture.
D Dividing the bone between two implants or interprosthetic or intercalary	Decision-making depends on “block-out analysis”^*. Subtype A (both prostheses stable): reduction and fixation Subtype B (one stable and one loose): revision surgery Subtype C (both loose): both joint revision surgery, total replacement
E Each of two bones supporting one arthroplasty or polyperiprosthetic	Decision-making depends on “block-out analysis” (e.g. separate assessment of femoral fracture with the stem of THA and acetabular fracture with cup)
F Facing and articulating with a hemiarthroplasty	Depending on displacement, conservative treatment is preferred.