To the Editor:

I found the recent Instuctional Course Lecture by Lorich, et.al., "Osteoporotic Pertrochanteric Hip Fractures", to be of great interest. However, I was rather surprised by the terminology used by the authors. According to AO/ASIF and OTA /1,2/, proximal femur fractures are divided into fractures of the femoral head (31C), the femoral neck (31B) and the trochanteric fractures (31A) which are subdivided into pertrochanteric (31A1 and 31A2) and intertrochanteric (31A3) fractures. Despite these accepted classifictions, the authors used the term "pertrochanteric hip fractures" instead of "trochanteric fractures".

In Fig. 2 they present the Evans´ classification of “intertrochanteric” fractures. But Evans published a classification of trochanteric fractures (3). The same applies to Fig. 3 where, in addition, A3.1 and A3.2 fractures are presented as unstable fractures. This is a mistake as in these types there is no defect of the medial cortex (i.e. the Adams´ arch) that would be responsible for the varus instability.

I know that the terminology of the trochanteric fractures is not uniform, e.g. 31A1 and 31A2 pertrochanteric fractures are often designated in the English literature as intertrochanteric fractures and the term “high subtrochanteric fracture” is often used for the 31A3 intertrochanteric fractures according to ASIF/OTA. But in my view, the authors of an Instructional Course Lecture should use precise terminology and not confuse stable and instable fractures.

1. Müller ME, Nazarian S, Koch P, Schatzker J. The Comprehensive Classification of Fractures of Long Bones. Berlin, Springer 1990

2. Orthopaedic Trauma Association Comittee for Coding and Classification. Fracture and dislocation compendium J. Orthop Trauma. 1996: 10 (Supp1) v-ix, 1-154

3. Evans EM. The treatment of trochanteric fractures of the femur. J Bone Joint Surg Br. 1949: 31: 190-203

Yours sincerely,

Jan Bartoníèek, MD Orthopaedic Department of 3rd Faculty of Medicine Charles University