Usefulness of Pre-operative CT Scan to Assess Lateral Wall Instability in Trochanteric Fractures

Background: Intertrochanteric (IT) femur fractures are increasingly prevalent, especially in the aging population, necessitating precise diagnostic tools for optimal surgical management. Conventional classification systems using plain radiographs have limitations in accurately assessing unstable fracture patterns, particularly those involving lateral wall deficiency. Methods: This prospective, single-centre study (September 2023–November 2024) evaluated the role of preoperative computed tomography (CT) in managing IT fractures with lateral wall involvement. The study included 33 patients (aged ≥55) with unstable lateral wall fractures treated with Proximal Femoral Nail (PFN). Preoperative CT parameters, including lateral wall thickness and fracture morphology, were assessed and correlated with intraoperative findings. Results: CT scans significantly altered fracture classification compared to radiographs alone. While 85.7% of fractures were classified as AO 2 on X-ray, CT reclassification revealed 63.6% as AO 2 and 36.4% as AO 3. The addition of CT led to a classification upgrade in 45.5% of cases, enhancing the detection of complex fractures. However, statistical analysis showed a weak agreement between X-ray and CT (Kappa = 0.012, p = 0.854), suggesting that while CT provides additional details, its impact on classification significance remains debatable. Conclusion: CT imaging enhances the assessment of intertrochanteric fractures, particularly in evaluating lateral wall integrity and comminution. While its statistical significance remains inconclusive, CT remains a valuable adjunct for improving surgical planning, optimizing fixation strategies, and potentially reducing failure rates in IT fractures.