Six-part classification of femoral intertrochanteric fractures
Authors: li kainan , wang zhenghao , lan hai 
Published: July 2022

Abstract
PURPOSE 3DCT data is currently insufficient for classifying femoral trochanter fractures. A novel classification approach for the six-part categorization of femoral intertrochanteric fractures was proposed based on 3D-CT images and fracture stability analysis in this study.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. The AO and six sections were categorized based on the patients' 3D-CT image data, and the stability was passed. The difference in the stability rate of two types of fractures was compared, and the definition was categorized. They were classified into stable and unstable fracture groups based on the six-part classification stability criteria. The following perioperative and postoperative indicators were counted for the two groups: operation time, perioperative blood loss, Harris score, fracture healing time, entire weight-bearing period, Fracture reduction quality, FIM, TUG, and PPMS scores. Statistical imaging and stability indicators: FHH, FNSA, Lmcn, TAD alterations, and examine if there are statistical differences between the two groups in the indicators above. Examine the six-part classification's inter-observer and internal reliability. RESULTS There were 107 males and 213 females among the 320 patients, with an average age of (79.32±11.26) years and an osteoporosis rate of 55.63 percent (178/320). The fracture stability rate of 39.69 percent (127/320) was studied using a six-part classification. The AO Classification fracture stability rate was 42.50 percent (136/320), with no significant difference (c2=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<0.001). The surgery time (P=0.280)；fracture reduction quality (P=0.062); FIM (P=0.075); TUG (P=0.191); PPMS (P=0.146) were as compared according to the six-part classification of stable and unstable fracture groups. No statistical significance. Perioperative blood loss (P<0.001), Harris score excellent and good rate (P=0.043), fracture healing time (P<0.001), and the entire weight-bearing duration (P=0.002) were statistically significant. The difference in FHH (P=0.046); the change in FNSA (P=0.003); the change in Lmcn (P=0.033); and the change in TAD (P=0.002) was statistically significant when compared to the relevant markers of imaging stability. Fracture stability had a substantial influence on Harris ratings at 3, 6, and 12 months following surgery, according to repeated measures analysis of variance. P<0.001; F(1,126)=32.604; F(1,126)=32.604; F(1,126)=32.60 F(1.893,238.508)=202.771, P0.001. The effect of time on Harris score is similarly significant, F(1.893,238.508)=202.771, P<0.001. Observer intra-observer ICC value is 0.941>0.75; inter-observer ICC value is 0.921>0.75, and intra-observer and inter-observer reliability are both good. CONCLUSION The six-part Classification of femoral intertrochanteric fractures based on 3D-CT images has a broader guiding relevance for femoral intertrochanteric fracture stability analysis. Clinicians will find the Classification simple to understand, and the diagnosis will be more consistent.