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

Shai Factor*, Etay Elbaz, Efi Kazum, Itay Pardo, Samuel Morgan, Tomer Ben-Tov, Amal Khoury, Yaniv Warschawski

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: 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. Methods: 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. Results: 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 (p = 0.21 and p = 0.14, respectively). Conclusions: 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.

Original languageEnglish
Pages (from-to)194-200
Number of pages7
JournalClinics in Orthopedic Surgery
Issue number2
StatePublished - Apr 2024


  • Fracture classification
  • Fracture fixation
  • Intramedullary
  • Subgrouping
  • Trochanteric fractures


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