Traction Internal Rotation Radiographs Aid in the Assessment of Lateral Femoral Wall Integrity in Intertrochanteric...

Area of Science:

• Orthopaedic Surgery
• Traumatology
• Radiology

Background:

• Lateral femoral wall failure is a significant risk in intertrochanteric (IT) fractures, potentially leading to catastrophic collapse.
• Accurate preoperative assessment of the lateral wall is crucial for successful fracture fixation and implant selection.

Purpose of the Study:

• To evaluate the utility of traction internal rotation (TIR) radiographs in assessing the lateral femoral wall in IT fractures.
• To determine if TIR radiographs can influence preoperative planning and implant choice for IT fracture fixation.

Main Methods:

• Seventy-four consecutive patients with AO Foundation/Orthopaedic Trauma Association AO/OTA 31A1-2 fractures were analyzed.
• Fracture fixation was performed using either a sliding hip screw (SHS) or a cephalomedullary nail (CMN).
• Preoperative assessment included standard radiographs and TIR views.

Main Results:

• No patient treated with a sliding hip screw (SHS) experienced lateral wall failure at the final follow-up.
• TIR radiographs provided a more accurate assessment of the lateral wall compared to standard views.
• The study suggests TIR imaging can optimize preoperative evaluation of fracture morphology.

Conclusions:

• Traction internal rotation (TIR) radiographs enhance the preoperative evaluation of intertrochanteric fractures, particularly concerning the lateral femoral wall.
• Utilizing TIR imaging can lead to improved implant selection and potentially reduce the risk of catastrophic fracture collapse.
• This technique is especially valuable when considering fixation with a sliding hip screw (SHS).