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A novel classification system based on the lateral view of 3D-CT for predicting the reducibility of intertrochanteric
Shiyun Qian1,2, Yong Zhu1,2, Kaihu Li3
1Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
Objective:
Current classifications for intertrochanteric fractures poorly predict the difficulty of achieving closed reduction. This study aimed to develop and validate a novel classification system based on the lateral view of three-dimensional computed tomography (3D-CT) to preoperatively assess reducibility.
Methods:
We retrospectively reviewed 609 patients with intertrochanteric fractures. After screening, 318 cases (117 AO/OTA 31-A1 and 201 AO/OTA 31-A2) were included. Based on preoperative 3D-CT, fracture morphology was categorized as flexed, neutral, or extended types. The intraoperative outcome of closed reduction was used to define fractures as reducible or irreducible.
Results:
Among the 318 fractures, 174 (54.7%) were reducible and 144 (45.3%) were irreducible. The reducible group included 105 flexed, 21 neutral, and 48 extended types. The irreducible group comprised 90 flexed-type and 54 extended-type fractures. Irreducible flexed-type and extended-type fractures were further subdivided into 3 distinct subtypes each, based on characteristic radiological features.
Conclusion:
The proposed classification system, which integrates the AO/OTA framework with 3D-CT morphology, effectively identifies fractures at high risk for irreducible closed reduction. This system can help surgeons avoid futile reduction attempts and guide the choice of an appropriate reduction strategy.
