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Updated: Jul 30, 2025
Imaging of the Microstructural Failure Mechanism in the Human Hip
Published on: September 29, 2023
Pathoanatomy of pertrochanteric fractures - a postmortem study
Jan Bartoníček1, Radek Bartoška2, Jan Alt3
1Department of Orthopaedics, First Faculty of Medicine, Charles University and Military University Hospital Prague, U Vojenské Nemocnice 1200, 169 02 Prague 6, Czech Republic; First Faculty of Medicine, Institute of Anatomy, Charles University, U Nemocnice 3, 128 00 Prague 2, Czech Republic.
This study re-evaluates pertrochanteric fractures using postmortem specimens, identifying three main fragments instead of four. Findings challenge the traditional AO/OTA classification, suggesting a revised understanding of fracture pathoanatomy.
Area of Science:
- Orthopedic Surgery
- Anatomy
- Trauma Research
Background:
- 3D CT studies question the AO/OTA classification of pertrochanteric fractures due to its limited reflection of reality.
- Previous CT analyses lacked detailed pathoanatomic insights, necessitating further investigation.
Purpose of the Study:
- To analyze the pathoanatomy of pertrochanteric fractures using postmortem specimens.
- To provide a more accurate understanding of fracture patterns and inform classification revisions.
Main Methods:
- Examination of 16 postmortem hip joint specimens with pertrochanteric fractures.
- Analysis of anteroposterior radiographs, fragment number and shape, and fracture line courses.
Main Results:
- Identification of three major fragments: proximal head/neck, distal diaphysis, and posterior flat fragment.
- Characterization of primary, secondary, and tertiary fracture lines.
- Posterior cortex defects and lesser trochanter avulsion identified as key instability factors.
Conclusions:
- The study supports revised pathoanatomic understanding of pertrochanteric fractures, aligning with recent CT findings.
- A new concept of three main fragments is proposed, challenging the traditional four-fragment model.
- Findings necessitate a revision of the current AO/OTA classification system for pertrochanteric fractures.
