Intertrochanteric (Reverse Oblique) Fracture Subclassifications AO/OTA 31-A3 Have No Effect on Outcomes or Postoperative Complications

• Published in: Clinics in orthopedic surgery Vol. 16; no. 2; pp. 194 - 200
• Main Authors: Factor, Shai, Elbaz, Etay, Kazum, Efi, Pardo, Itay, Morgan, Samuel, Ben-Tov, Tomer, Khoury, Amal, Warschawski, Yaniv
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Orthopaedic Association 01.04.2024; 대한정형외과학회
• Subjects: Original; 정형외과학; Fracture fixation; Intramedullary; Subgrouping; Fracture classification; Trochanteric fractures
• DOI: 10.4055/cios23204
• ISSN: 2005-291X

Reverse oblique intertrochanteric fractures (ROFs) are unstable extracapsular hip fractures that present a mechanical challenge. These fractures are classified as AO/Orthopaedic Trauma Association (OTA) 31-A3 according to the Trauma Association classification system and can further be subclassified into 3 subtypes based on their specific characteristics. The study aimed to evaluate and compare the radiographic and clinical outcomes of the 3 subtypes of ROFs. A retrospective study was conducted at a single high-volume, tertiary center, where data were collected from electronic medical records of consecutive patients who underwent surgical fixation of AO/OTA 31-A3 fractures. Patients with less than 1-year follow-up, pathological fractures, and revision surgery were excluded. The subtypes of fractures were classified as 31-A3.1 (simple oblique), 31-A3.2 (simple transverse), and 31-A3.3 (wedge or multi-fragmentary). The operation was done using 4 different fixation methods, and radiological evaluation was performed at routine intervals. The final population consisted of 265 patients (60.8% women) with a mean age of 77.4 years (range, 50-100 years) and the mean follow-up time was 35 months (range, 12-116 months). The incidence of medical complications was similar across the groups. However, there was a trend toward a higher incidence of orthopedic complications and revision rates in the 31-A3.2 group, although this was not statistically significant ( = 0.21 and = 0.14, respectively). Based on the findings of this study, no significant differences were observed between the groups, indicating that the subclassifications of AO/OTA 31-A3 fractures do not have a significant impact on surgical outcomes or the occurrence of postoperative complications.