Six‐Part Classification of Femoral Intertrochanteric Fractures: A Classification Method to Improve the Diagnosis Rate of Unstable Fractures

Abstract

Objective Three‐dimensional (3D)‐CT data is currently insufficient for classifying femoral trochanter fractures. Fracture classification based on fracture stability analysis is helpful to evaluate the prognosis of patients after internal fixation. Currently, there is a lack of fracture classification methods based on 3D‐CT images and fracture stability analysis. The aim of this study was to propose a new six‐part classification method for intertrochanteric fractures of femur based on 3D‐CT images and fracture stability analysis to improve the diagnosis rate of unstable fractures. Method From January 2009 to December 2019, 320 patients receiving intramedullary nail surgery for femoral intertrochanteric fractures at Chengdu University's Affiliated Hospital were studied retrospectively. AO and six‐part classifications were undertaken according to the 3D‐CT image data of the patients, and the stability rates of two classifications were compared. According to the six‐part classification stability criteria, the patients were divided into a stable and an unstable fracture group. The perioperative and follow‐up indicators of the two groups were statistically analyzed, and the six‐part classification's inter‐observer and internal reliability was examined. Results There were 107 men and 213 females women the 320 patients, with an average age of 79.32 ± 11.26 years and an osteoporosis rate of 55.63% (178/320). The fracture stability rate of 39.69% (127/320) was studied using a six‐part classification method. The AO classification fracture stability rate was 42.50% (136/320), with no significant difference (χ2 = 0.523, p = 0.470 > 0.05). There is no statistically significant difference between the two classification techniques in the examination of fracture stability (McNemer difference test p = 0.306 > 0.05; Kappa consistency test p 0.75, the inter‐observer ICC value was 0.921 > 0.75, and the intra‐observer and inter‐observer reliability were both good. Conclusion The six‐part classification of femoral intertrochanteric fractures based on 3D‐CT images has broader guiding relevance for femoral intertrochanteric fracture stability analysis. Clinicians will find this classification simpler and more consistent than the AO classification.

Keywords

• AO Classification
• Classification
• Fracture, Intertrochanteric
• Internal Fixation
• Six‐Part Classification
• Stability