7. Dossick and Dorr classification of proximal femoral geometry

#### 7.1. Introduction

Based on the calcar-to-canal ratio which is defined as the diameter of the femur at the midportion of the lesser trochanter divided by the diameter at a point 10 cm distal [7].

8. Vancouver classification of intraoperative periprosthetic femur fractures

Classifications Used in Total Hip Arthroplasty http://dx.doi.org/10.5772/intechopen.77231 27

Type A2: Circelage wire if using proximally porous coated stem and can be ignored if using

fully porous coated stem and there is no distal extension into diaphysis.

Type C1: Morselized bone graft bypass stem and cortical allograft.

Type C2: Circelage wire bypass stem and cortical allograft.

Type B1: Bypassing stem cortical allograft fixation. Type B2: Circelage wire cortical allograft fixation. Type B3: Long stem with cortical allograft fixation.

around total hip arthroplasty

Type A: Proximal metaphyseal.

A2: Undisplaced linear crack.

A3: Displaced or unstable fractures.

B3: Displaced or unstable fractures.

C3: Displaced or unstable fracture [8].

Type C: Distal diaphyseal fractures.

C2: Undisplaced linear crack.

C1: Cortical perforation.

8.2. Clinical applications

Type A1: Bone graft alone.

Type A3: Needs fixation.

Type C3: ORIF (Figure 6).

A1: Cortical perforation.

Type B: Proximal diaphyseal. B1: Cortical perforation.

B2: Undisplaced linear crack.

8.1. Classifications

#### 7.2. Classification

Type A: Calcar-to-canal ratio < 0.5.

No thinning of cortices on AP or lateral radiographs.

Type B: Calcar-to-canal ratio 0.5–0.75.

Thinning of the posterior cortex on the lateral view.

Type C: Calcar-to-canal ratio > 0.75.

Thinning of cortices on both views (Stovepipe femur) (Figure 5).

#### 7.3. Clinical significance

Type A suitable for cementless femoral stem, type C requires use of cemented stem and type B is intermediate.

Figure 5. Dossick and Dorr classification.
