Research Article| Volume 33, ISSUE 8, P713-715, October 2002

Classification of trochanteric fracture of the proximal femur: a study of the reliability of current systems


      Five observers using the Jensen modification of the Evans classification and the AO classification (with and without subgroups) classified the radiographs of 88 trochanteric hip fractures. Each observer classified the radiographs independently on two occasions 3 months apart. Kappa statistical analysis was used for determination of intra- and inter-observer variation.
      For the Jensen classification, the mean kappa value was 0.52 (range: 0.44–0.60) for intra-observer variation and 0.34 (range: 0.17–0.38) for inter-observer variation. For the AO system with subgroups, the mean kappa value was 0.42 (range: 0.20–0.65) for intra-observer variation and 0.33 (range: 0.14–0.48) for inter-observer variation. For the AO classification system without subgroups, the mean kappa value was 0.71 (range: 0.60–0.81) for intra-observer variation and 0.62 (range: 0.50–0.71) for inter-observer variation.
      We recommend classifying trochanteric fractures into three groups as that of the AO system without the subgroups. For ease of use, these three groups may be termed stable trochanteric, unstable trochanteric and trans-trochanteric. Neither the Jensen classification nor the AO classification with subgroups is an acceptable classification system for trochanteric hip fractures.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Pynsent PB, Fairbank JCT, Carr AJ. Classification of musculo-skeletal trauma. Oxford: Butterworth, 1999.

        • Evans E.M.
        The treatment of trochanteric fractures of the femur.
        J Bone Joint Surg Br. 1949; 31: 190-203
        • Jensen J.S.
        Classification of trochanteric fractures.
        Acta Orthop Scand. 1980; 51: 803-810
        • Jensen J.S.
        • Michaelsen M.
        Trochanteric femoral fractures treated with McLaughlin osteosynthesis.
        Acta Orthop Scand. 1975; 46: 795-803
        • Colton C.L.
        Telling the bones.
        J Bone Joint Surg Br. 1991; 73: 362
      2. Muller ME, Nazarian S, Koch P, et al. The comprehensive classification of fractures of long bones. Berlin: Springer, 1990.

      3. Altman DG. Practical statistics for medical research. 3rd ed. Chapman and Hall, 1995, pp. 403–9.

        • Svanholm H.
        • Starklint H.
        • Gundersen H.J.G.
        • et al.
        Reproducibility of histomorphologic diagnosis with special reference to kappa statistic.
        APMIS. 1989; 97: 689-698
      4. Burstein AH. Fracture classification systems: do they work and are they useful? J Bone Joint Surg Am 1993;75(A):1743–4 [editorial].

        • Schipper I.B.
        • Steyerberg E.W.
        • Castelein R.M.
        • vanVugt A.B.
        Reliability of the AO/ASIF classification for pertrochanteric femoral fractures.
        Acta Orthop Scand. 2001; 72: 36-41
        • De Boeck H.
        Classification of hip fractures.
        Acta Orthop Belg. 1994; 60: 106-109
        • Newey M.L.
        • Ricketts D.
        • Roberts L.
        The AO classification of long bone fractures: an early study of its use in clinical practice.
        Injury. 1993; 24: 309-312
        • Andersen E.
        • Jorgensen L.G.
        • Hededam L.T.
        Evans’ classification of trochanteric fractures: an assessment of the interobserver and intraobserver reliability.
        Injury. 1990; 21: 377-378
        • Gerchen P.M.
        • Nielsen J.O.
        • Olesen B.
        Poor reproducibility of Evans’ classification of trochanteric fracture; assessment of 4 observers in 52 cases.
        Acta Orthop Scand. 1993; 64: 71-81
        • Haidukewych G.J.
        • Israel T.A.
        • Berry D.J.
        Reverse obliquity fractures of the intertrochanteric region of the femur.
        J Bone Joint Surg Am. 2001; 83: 643-650
        • Moore J.R.
        Fractures of the upper end of the femur including fracture dislocations at the hip joint.
        Am J Surg. 1939; 44: 117-134