The Johansson classification of periprosthetic hip fractures was the first classification system proposed and is the simplest 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.
Johansson Classification of Periprosthetic Hip Fractures
- type I: fracture proximal to the tip of the prosthesis with the stem still in contact with the medullary canal
- type II: fracture extends distal to the tip of the prosthesis, with dislodgement of the stem from the medullary canal of the distal fragment
- type III: fracture entirely distal to the tip of the prosthesis
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 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
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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