Evaluation of reduction quality and implant positioning in intertrochanteric fracture fixation: A review of key radiographic parameters.

Abstract

Intertrochanteric fractures, prevalent among older adults, pose significant clinical challenges due to high morbidity, mortality, and complication rates. Despite advancements in surgical methods and implant technology, one-year mortality remains between 20% and 30%, with up to 20% of survivors requiring revision surgery due to mechanical complications. Accurate fracture reduction and precise implant positioning are critical determinants of successful outcomes. This review synthesizes current literature on key radiographic parameters essential for evaluating fracture reduction quality and implant placement in intertrochanteric fracture fixation. Standardized intraoperative imaging techniques, such as correct anteroposterior and lateral fluoroscopic views, are fundamental for identifying malalignment. Important radiographic measures include the neck shaft angle, greater trochanter orthogonal line, anterior cortical line, and calcar displacement assessment. Reduction quality indices, notably the Baumgaertner and Chang Reduction Quality Criteria, provide reliable frameworks for predicting mechanical complications. Additionally, implant positioning parameters-including tip-apex distance, Calcar-referenced tip-apex distance, Cleveland zones, and Parker's ratio index-are discussed as predictors of mechanical complications. Enhanced understanding and application of these radiographic criteria can improve surgical precision, reduce complications, and ultimately optimize patient outcomes in intertrochanteric fracture management.