Accuracy of Preoperative Planning Helical Blade Length during Treatment of Intertrochanteric Hip Fractures with...

Intertrochanteric hip fractures are commonly treated with cephalomedullary nailing. One time-consuming aspect of the procedure is intraoperatively measuring the helical blade length. This investigation sought to determine if preoperative imaging can be reliably used to predict helical blade length and therefore reduce operative time accurately. This was a single-center, single-surgeon retrospective chart review. All subjects were operated on by the senior author at a single urban level-1 trauma center. Each patient underwent cephalomedullary nailing using a helical blade. The medical records were reviewed for demographic, imaging, and operative data. Two raters preoperatively recorded head element length, subsequently estimated helical blade implant sizes, and actual implant length used intraoperatively. In total, 134 patients were analyzed. The results demonstrated that radiographs (R2 = 0.337, p < 0.001) and computed tomography (CT) imaging (R2 ≥ 0.435, p < 0.001) could not reliably predict helical blade length, and that radiographs were more accurate than CT scans in predicting actual implant size (p < 0.001). Preoperative imaging modalities predicted the exact size only 23.8% of the time using radiographs and 17.2% of the time using CT. Preoperative helical blade implant size was estimated accurately 24% of the time. However, raters were successful in estimating the length of the helical blade within three sizes. We demonstrate that preoperative imaging modalities are unable to accurately predict helical blade length.