Journal of Shandong University (Health Sciences) ›› 2025, Vol. 63 ›› Issue (12): 61-73.doi: 10.6040/j.issn.1671-7554.0.2025.0443

• Clinical Medicine • Previous Articles    

Classification and treatment of irreducible intertrochanteric femoral fractures based on CT 3-D imaging

LIN Jinxiu, LI Ye, YIN Dechao, WANG Kunpeng, TAN Baoli   

  1. Department of Orthopedics, The First Hospital of Zibo City, Zibo 255200, Shandong, China
  • Published:2025-12-19

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Abstract: Objective To establish a classification system for irreducible intertrochanteric fractures of the femur(IIFF)based on CT three-dimensional imaging and validate its clinical value in preoperative identification and intraoperative reduction. Methods A retrospective analysis was conducted on 678 patients with intertrochanteric fractures admitted between January 2015 and December 2021. Seventy-eight IIFF cases were identified, defined as those achieving “poor” reduction quality(Baumgaertner/Kim criteria)after ≤3 attempts of standard closed reduction. A novel 5-type classification system(Type Ⅰ: lesser trochanter-related; Type Ⅱ: greater trochanter-related; Type Ⅲ: reverse intertrochanteric; Type Ⅳ: completely displaced; Type Ⅴ: combined with subtrochanteric fracture)was proposed based on preoperative CT 3D imaging characteristics, including fracture morphology, displacement direction, and soft tissue attachment. Corresponding reduction strategies were formulated. Seventy-eight matched controls were selected from 600 non-IIFF patients via 1∶1 propensity score matching(PSM)for factors including age, sex, and AO classification. Results The incidence of IIFF was 11.5%(78/678). After applying targeted reduction strategies, the acceptable reduction rate in the IIFF group was 83.3%(65/78), showing no significant difference compared to the control group(84.6%, 66/78; P>0.05). Operative time in the IIFF group ［(67.3±24.2)min］ was significantly longer than that in the control group ［(55.8±19.5)min］(P<0.001), and intraoperative blood loss ［(210.5±75.1)mL］ was significantly greater than in controls ［(165.3±65.8)mL］(P<0.001). No significant differences were observed in Harris hip scores, fracture healing time, or complication rates at the final follow-up(all P>0.05). Conclusion The CT 3D imaging-based classification system enables effective preoperative identification of IIFF. The corresponding targeted reduction strategies, although increasing operative time and blood loss, can achieve satisfactory reduction and clinical outcomes comparable to those of reducible fractures, demonstrating significant clinical guiding value.

Key words: Irreducible intertrochanteric femoral fracture, CT 3D imaging, Classification, Reduction strategy, Internal fixation

CLC Number: 

  • R683.3
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