Abstract
The present study compared a 3-dimensional computed tomography (3DCT) classification (Nakano classification) with conventional x-ray classifications (Jensen classification and AO classification) in 44 patients with trochanteric femoral fractures, and evaluated the patterns of fracture lines using 3DCT images. The concordance rate between the Jensen and 3DCT classification, and between the AO and 3DCT classification was 65.9% and 75.0%, respectively. 3DCT scans enabled the creation of detailed images of fracture lines. The anterior fracture line was found to run along the intertrochanteric crest in 90.9% of patients, while the location of the posterior fracture line was in the same approximate position in all patients, including those with comminuted fractures (34.1%). Posterior destruction along lateral fracture lines was present in 63.6% of patients. Furthermore, the preoperative and postoperative CT images of 33 patients with fractures treated via insertion of short femoral nails demonstrated that there was difficulty reducing greater trochanteric fractures. This included reducing fracture sites separated by nail insertion (42.4%) and greater trochanteric fracture sites displaced after surgery (54.5%), suggesting that the use of short femoral nails is limited.
