A novel computed tomography-based three-column MLP classification of intertrochanteric fracture

Abstract

Abstract Background : The aim of the present study was to introduce a novel three-dimensional computed tomography (3DCT)-based three-column classification (named “MLP classification system”) of intertrochanteric fracture, and evaluate its reproducibility and reliability. Methods : From September 2020 to September 2022, a total of 258 consecutive patients (60 male, 198 female; mean age 81.3 years) with intertrochanteric fracture were included in this study. The fracture in each case was assessed using a novel three-dimension computed tomography-based three-column classification. Two examiners tested the intra and inter-observer reliability of this new classification system using kappa variance. Results : Intertrochanteric region was divided into medial column, lateral column and posterior column. Intertrochanteric fractures were documented as M0/1/2L0/1/2/3P0/1/2/3. All fractures were classifiable into the new classification system. The intra and inter-observer kappa value were 0.91 and 0.82 respectively, indicating almost perfect reliability. Conclusion : This novel 3DCT-based MLP classification system for intertrochanteric fractures is comprehensive, reproducible with good agreement. It is based on proximal femur biomechanic characteristics and traumatic mechanism, contributing to formulate more reasonable treatment protocols involving various late-model internal fixation systems.