7. Fielding classification
Subtrochanteric fractures is based
on the level of the subtrochanteric
region through which the fracture
extends.
• type I: at the level of the lesser
trochanter (most common)
• type II: within the region 2.5 cm
below the lesser trochanter
• type III: within the region 2.5 cm
to 5 cm below the lesser
trochanter (least common)
8. Seinsheimer’s classification
• Type I: Nondisplaced fracture or one with less than
• 2 mm of displacement
• Type II: Two-part fracture
• Type IIa: Transverse fracture
• Type IIb: Spiral configuration with the lesser trochanter
• attached to proximal fragment
• Type IIc: Spiral configuration with the lesser trochanter
• attached to distal fragment
• Type III: Three-part fracture
• Type IIIa: Three-part spiral configuration with the lesser
• trochanter a part of the third fragment
• Type IIIb: Three-part spiral configuration with the third
• part a butterfly fragment
• Type IV: Comminuted fracture with four or more
• Fragments
• Type V: Subtrochanteric - intertrochanteric configuration
28. Opening the fascia lata
• The fascia lata is incised with a
scalpel and split with scissors
parallel to the skin incision,
along its fibers.
• The muscle fascia over the
vastus lateralis is exposed.
29. Separation of vastus lateralis from fascia lata
• In the next step, the vastus
lateralis is separated by blunt
dissection from the fascia lata.
30. • The vastus lateralis is now
retracted anteromedially.
• The muscle fascia investing the
vastus lateralis is incised about 1
cm anterior to the intermuscular
septum.
31. Mobilization of vastus lateralis from intermuscular
septum
• The muscle is detached from the
lateral intermuscular septum
and the linea aspera with a
periosteal elevator.
32.
33.
34. Minimally invasive ostheosynthesis approach
• They vary according to the
fracture location:
• proximal (segment 1)
• mid-shaft (segment 2)
• distal femur (segment 3)
sections.
35. MIO approach to the subtrochanteric region
Skin incision
• The lateral proximal incision
starts at the greater trochanter
and continues distally as far as
needed.
41. • Subtrochanteric fracture of
femur without trauma in a
patient with a new onset
fracture. The figure shows a
subtrochanteric fracture in a 66-
yr-old woman with a history of 8
yr risedronate treatment.