A novel three-dimensional classification system for intertrochanteric fractures based on computed tomography findings

Area of Science:

• Orthopedic surgery
• Radiology
• Biomedical engineering

Background:

• Femoral intertrochanteric fractures are common, particularly in elderly patients.
• Existing classification systems may not fully capture fracture complexity.
• Accurate characterization is crucial for effective treatment planning.

Purpose of the Study:

• To introduce a novel three-dimensional fragment-based classification system for femoral intertrochanteric fractures.
• To evaluate the system's ability to provide more detailed fracture characterization.
• To assess the frequency of different fragment types in a patient cohort.

Main Methods:

• Computed tomography (CT) scans were used to analyze 95 intertrochanteric fractures.
• A classification system was developed defining fragments as neck, posterior greater trochanter, anterior greater trochanter, lesser trochanter, and shaft.
• Fractures were categorized by the number of floating fragments (2- to 5-fragment).

Main Results:

• The system identified fractures with 2 fragments (32.6%) and ≥3 fragments (67.4%).
• Anterior greater trochanter fragments, not classified by conventional systems, were present in 30.5% of cases.
• Two cases (2.1%) presented as 5-fragment fractures.

Conclusions:

• The novel 3D fragment-based system provides a more detailed characterization of femoral intertrochanteric fractures.
• Inclusion of the anterior greater trochanter fragment enhances classification accuracy.
• This system offers improved evaluation capabilities compared to conventional methods.