Lateral Femoral Neck and Peritrochanteric Fractures: Anatomical Classifications and Pre-Operative Reduction...

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Geriatric Medicine

Background:

• Lateral femoral neck and peritrochanteric fractures are common and challenging in the elderly.
• Traditional classification systems have limitations in reproducibility and clinical applicability.
• Trabecular architecture's role in fracture behavior and treatment is gaining attention.

Purpose of the Study:

• To review current evidence on classification systems, trabecular patterns, reduction techniques, and fixation for hip fractures.
• To evaluate the reliability and clinical relevance of existing and emerging classification methods.
• To emphasize the importance of trabecular alignment in optimizing surgical outcomes.

Main Methods:

• Conducted a narrative review of studies from PubMed/MEDLINE, Embase, and Scopus up to May 2026.
• Included original studies, reviews, and biomechanical investigations on proximal femur fractures.
• Qualitatively analyzed data focusing on interobserver reliability, biomechanics, and clinical outcomes.

Main Results:

• Conventional classification systems show moderate interobserver reliability (κ = 0.30–0.60).
• Trabecular architecture distinguishes stable intradigital from unstable extradigital fractures.
• Inadequate reduction with trabecular misalignment increases risks of varus collapse and implant cut-out.
• Cephalomedullary nails show lower reoperation rates (5–8%) than dynamic hip screws (10–15%) in unstable fractures.

Conclusions:

• Management of hip fractures requires integrating trabecular biomechanics beyond traditional classifications.
• Restoring trabecular alignment is critical for optimal outcomes, alongside neck-shaft angle and tip-apex distance.
• Further prospective studies are needed to validate trabecular-based classifications and standardize reduction techniques.