{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T09:34:17Z","timestamp":1771234457843,"version":"3.50.1"},"reference-count":36,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T00:00:00Z","timestamp":1771027200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Reverse-oblique femoral fractures are regarded as highly unstable and are still associated with high complication and failure rates. A new classification system is said to facilitate risk assessment and decision-making. Methods: Over ten years, 7804 patients with per\/subtrochanteric fractures were screened in this retrospective analysis. A total of 552 patients with a reverse-oblique fracture pattern were included. The fractures were classified according to the new classification system. The choice of implants, complication rates, revision surgery, and time of surgery were recorded. Radiological outcome parameters and dislocation were measured. Results: For the classification, a good intra-rater reliability (r = 0.77) and inter-rater reliability (k = 0.64) were calculated. The complication rate was overall 19% (n = 105). More than 60% of complications needed revision surgery. The most common complications were cut-out and implant failure (3%); only Parker\u2019s ratio, as a radiological parameter, had prognostic value. Malreduction had a negative impact on mal- or non-unions (p &lt; 0.01), and a trend towards higher overall complications (p = 0.52). Prolonged time of surgery increased the overall complication rate (r = 0.2, p &lt; 0.001). The same was found after open reduction (p = 0.005, OR 2.00). The use of cerclage wires had no positive or negative effects. The use of short or long implants did not influence the outcome. Conclusions: Reverse-oblique femoral fractures are associated with a high complication rate. Short implants can be safely used in cases without severe dislocation if a sufficient working length is considered. Anatomical reduction benefits the outcome as long as it can be performed closed. The classification system presents good inter- and intra-rater reliability.<\/jats:p>","DOI":"10.3390\/jcm15041502","type":"journal-article","created":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T08:38:39Z","timestamp":1771231119000},"page":"1502","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Treatment Strategies and Complications in Reverse-Oblique Trochanteric Femur Fractures and Evaluation of a New Classification System"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8591-5079","authenticated-orcid":false,"given":"Robert","family":"Breuer","sequence":"first","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, Klinik Donaustadt, Langobardenstra\u00dfe 122, 1220 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rainer","family":"Fiala","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, Klinik Donaustadt, Langobardenstra\u00dfe 122, 1220 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Theresa","family":"Dorner","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, Klinik Donaustadt, Langobardenstra\u00dfe 122, 1220 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2844-9026","authenticated-orcid":false,"given":"Barbara","family":"Strasser-Kirchweger","sequence":"additional","affiliation":[{"name":"Department of Psychology, Centre for Cognitive Neuroscience, University of Salzburg, Hellbrunnerstra\u00dfe 34, 5020 Salzburg, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9739-6176","authenticated-orcid":false,"given":"Harald Kurt","family":"Widhalm","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mehdi","family":"Mousavi","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, Klinik Donaustadt, Langobardenstra\u00dfe 122, 1220 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikolaus Wilhelm","family":"Lang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1007\/s11657-013-0140-5","article-title":"Incidence of hip fractures in Germany, 1995\u20132010","volume":"8","author":"Icks","year":"2013","journal-title":"Arch. Osteoporos."},{"key":"ref_2","first-page":"e075","article-title":"Comparison of reamed long and short intramedullary nail constructs in unstable intertrochanteric femur fractures","volume":"3","author":"Blum","year":"2020","journal-title":"OTA Int. Open Access J. Orthop. Trauma"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1007\/s00402-022-04345-0","article-title":"Biomechanical stability of short versus long proximal femoral nails in osteoporotic subtrochanteric A3 reverse-oblique femoral fractures: A cadaveric study","volume":"143","author":"Linhart","year":"2022","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2239","DOI":"10.1007\/s00198-012-1964-3","article-title":"A systematic review of hip fracture incidence and probability of fracture worldwide","volume":"23","author":"Kanis","year":"2012","journal-title":"Osteoporos. Int."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2209","DOI":"10.1016\/j.injury.2018.10.010","article-title":"Hip fractures\u2014Treatment and functional outcome. The development over 25 years","volume":"49","author":"Turesson","year":"2018","journal-title":"Injury"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"166","DOI":"10.5312\/wjo.v10.i3.166","article-title":"Changing trends in the mortality rate at 1-year post hip fracture\u2014A systematic review","volume":"10","author":"Downey","year":"2019","journal-title":"World J. Orthop."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"643","DOI":"10.2106\/00004623-200105000-00001","article-title":"Reverse Obliquity Fractures of the Intertrochanteric Region of the Femur","volume":"83","author":"Haidukewych","year":"2001","journal-title":"J. Bone Jt. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1097\/BOT.0000000000000187","article-title":"Unstable Pertrochanteric Femoral Fractures","volume":"28","author":"Kregor","year":"2014","journal-title":"J. Orthop. Trauma"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.1016\/j.injury.2005.04.014","article-title":"Two-hole side-plate DHS in the treatment of intertrochanteric fracture: Results and complications","volume":"36","author":"Laohapoonrungsee","year":"2005","journal-title":"Injury"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1685","DOI":"10.1016\/j.injury.2016.05.015","article-title":"New classification focusing on the relationship between the attachment of the iliofemoral ligament and the course of the fracture line for intertrochanteric fractures","volume":"47","author":"Futamura","year":"2016","journal-title":"Injury"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1016\/j.injury.2005.02.004","article-title":"Reverse obliquity and transverse fractures of the trochanteric region of the femur; a review of 101 cases","volume":"36","author":"Brammar","year":"2005","journal-title":"Injury"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1016\/j.injury.2012.12.010","article-title":"Sliding hip screw versus IM nail in reverse oblique trochanteric and subtrochanteric fractures. A study of 2716 patients in the Norwegian Hip Fracture Register","volume":"44","author":"Matre","year":"2013","journal-title":"Injury"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"372","DOI":"10.2106\/00004623-200203000-00007","article-title":"Treatment of Reverse Oblique and Transverse Intertrochanteric Fractures with Use of an Intramedullary Nail or a 95\u00b0 Screw-Plate","volume":"84","author":"Sadowski","year":"2002","journal-title":"J. Bone Jt. Surg."},{"key":"ref_14","first-page":"128","article-title":"Implant options for the treatment of intertrochanteric fractures of the hip: Rationale, evidence, and recommendations","volume":"99","author":"Baumgaertner","year":"2017","journal-title":"Bone Jt. J."},{"key":"ref_15","first-page":"40","article-title":"A comparison of two fixation methods for femoral trochanteric fractures: A new generation intramedullary system vs sliding hip screw","volume":"14","author":"Carulli","year":"2017","journal-title":"Clin. Cases Miner. Bone Metab."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Radaideh, A.M., Qudah, H.A., Audat, Z.A., Jahmani, R.A., Yousef, I.R., and Saleh, A.A. (2018). Functional and Radiological Results of Proximal Femoral Nail Antirotation (PFNA) Osteosynthesis in the Treatment of Unstable Pertrochanteric Fractures. J. Clin. Med., 7.","DOI":"10.3390\/jcm7040078"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1097\/BOT.0b013e31826fc11f","article-title":"Treatment of Pertrochanteric Fractures (OTA 31-A1 and A2): Long Versus Short Cephalomedullary Nailing","volume":"27","author":"Hou","year":"2013","journal-title":"J. Orthop. Trauma"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1097\/BOT.0b013e3182a7131c","article-title":"Short Versus Long Intramedullary Nails for Treatment of Intertrochanteric Femur Fractures (OTA 31-A1 and A2)","volume":"28","author":"Boone","year":"2014","journal-title":"J. Orthop. Trauma"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1097\/BOT.0000000000000286","article-title":"Nailing Intertrochanteric Hip Fractures: Short Versus Long; Locked Versus Nonlocked","volume":"29","author":"Kanakaris","year":"2015","journal-title":"J. Orthop. Trauma"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1007\/s10195-016-0405-z","article-title":"Long versus short cephalomedullary nail for trochanteric femur fractures (OTA 31-A1, A2 and A3): A systematic review","volume":"17","author":"Dunn","year":"2016","journal-title":"J. Orthop. Traumatol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2768","DOI":"10.1007\/s11999-013-2948-0","article-title":"Which implant is better for treating reverse obliquity fractures of the proximal femur: A standard or long nail?","volume":"471","author":"Okcu","year":"2013","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"112725","DOI":"10.1016\/j.injury.2025.112725","article-title":"Surgical treatment of reversed oblique trochanteric femur fractures: Clinical outcome and introduction of a novel surgical classification","volume":"56","author":"Breuer","year":"2025","journal-title":"Injury"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1007\/s00113-013-2525-8","article-title":"Subtrochant\u00e4re femurfrakturen","volume":"116","author":"Ulmar","year":"2013","journal-title":"Unfallchirurg"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Lang, N.W., Breuer, R., Beiglboeck, H., Munteanu, A., Hajdu, S., Windhager, R., and Widhalm, H.K. (2019). Migration of the lag screw after intramedullary treatment of AO\/OTA 31.A2.1-3 pertrochanteric fractures does not result in higher incidence of cut-outs, regardless of which implant was used: A comparison of gamma nail with and without U-blade (RC) lag scr. J. Clin. Med., 8.","DOI":"10.3390\/jcm8050615"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1302\/0301-620X.96B8.33644","article-title":"Predictors of failure for cephalomedullary nailing of proximal femoral fractures","volume":"96","author":"Kashigar","year":"2014","journal-title":"Bone Jt. J."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Moja, L., Piatti, A., Pecoraro, V., Ricci, C., Virgili, G., Salanti, G., Germagnoli, L., Liberati, A., and Banfi, G. (2012). Timing Matters in Hip Fracture Surgery: Patients Operated within 48 Hours Have Better Outcomes. A Meta-Analysis and Meta-Regression of over 190,000 Patients. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0046175"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1097\/BOT.0000000000000284","article-title":"What Makes an Intertrochanteric Fracture Unstable in 2015? Does the Lateral Wall Play a Role in the Decision Matrix?","volume":"29","author":"Tawari","year":"2015","journal-title":"J. Orthop. Trauma"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s13018-019-1414-4","article-title":"Risk factors for implant failure in reverse oblique and transverse intertrochanteric fractures treated with proximal femoral nail antirotation (PFNA)","volume":"14","author":"Hao","year":"2019","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1823","DOI":"10.1007\/s00590-019-02495-3","article-title":"Short versus long intramedullary nails for treatment of intertrochanteric femur fractures (AO 31-A1 and AO 31-A2): A systematic review","volume":"29","author":"Bovbjerg","year":"2019","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.1016\/j.injury.2012.05.004","article-title":"Expandable proximal femoral nails versus 95 8 dynamic condylar screw-plates for the treatment of reverse oblique intertrochanteric fractures","volume":"43","author":"Elis","year":"2012","journal-title":"Injury"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/S0020-1383(03)00208-0","article-title":"Second-generation cephalomedullary nails in the treatment of reverse obliquity intertrochanteric fractures of the proximal femur","volume":"35","author":"Honkonen","year":"2004","journal-title":"Injury"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"50","DOI":"10.5435\/JAAOS-D-15-00325","article-title":"Nail Length in the Management of Intertrochanteric Fracture of the Femur","volume":"24","author":"Horwitz","year":"2016","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2291","DOI":"10.2106\/JBJS.20.01904","article-title":"Should Pertrochanteric and Subtrochanteric Fractures Be Treated with a Short or Long Intramedullary Nail?: A Multicenter Cohort Study","volume":"103","author":"Viberg","year":"2021","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1007\/s00590-022-03240-z","article-title":"The role of cerclage wiring in the management of subtrochanteric and reverse oblique intertrochanteric fractures: A meta-analysis of comparative studies","volume":"33","author":"Hantouly","year":"2022","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1992","DOI":"10.1016\/j.injury.2015.07.001","article-title":"Subtrochanteric fracture: The effect of cerclage wire on fracture reduction and outcome","volume":"46","author":"Hoskins","year":"2015","journal-title":"Injury"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jor.2021.02.012","article-title":"CCD angle & hip fractures\u2014Predictor of fracture symmetry?","volume":"24","author":"Thalmann","year":"2021","journal-title":"J. Orthop."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/4\/1502\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T08:53:50Z","timestamp":1771232030000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/4\/1502"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,14]]},"references-count":36,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["jcm15041502"],"URL":"https:\/\/doi.org\/10.3390\/jcm15041502","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,14]]}}}