The role of preoperative computed tomography in surgical planning of intertrochanteric femur fractures fixation

Background: A precise preoperative evaluation of stability of intertrochanteric fractures is crucial for surgical planning. Three dimensional CT scanning is a useful tool for understanding the exact type of fracture pattern. Methods: A prospective study included 40 patients with intertrochanteric femoral fractures. They were classified into stable and unstable intertrochanteric fractures according to the X-ray based AO/OTA classification and according to Nakano 3D-CT classification and both classifications were correlated. The patients were operated on using dynamic hip screw (DHS) and were assessed radiologically and clinically by Harris hip score (HHS) after 6 months. Results: There was significant statistical difference (p=0.031) and relation (p<0.001) between X-ray based AO/OTA classification and 3D-CT classification. Six cases from the 24 cases with stable pattern in AO/OTA system have unstable patterns in the 3D-CT (25%) and their percent from the 22 unstable patterns in 3D-CT is 27.27% and their percent from the total number of patients in the study is 15%. Conclusions: The superolateral support in the form of the greater trochanter which affects the lateral wall thickness is as important as the posteromedial lesser fragment in assessing the stability of the fracture pattern.