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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Evaluation of reduction quality and implant positioning in intertrochanteric fracture fixation: A review of key radiographic parameters
Matthias Wittauer, Joseph Henry, Guillermo Sánchez-Rosenberg, Anton Philip Lambers, Christopher W Jones, Piers J Yates
Matthias Wittauer, Joseph Henry, Christopher W Jones, Piers J Yates, Department of Orthopaedic Surgery, Fremantle and Fiona Stanley Hospitals, Perth 6150, Western Australia, Australia
Matthias Wittauer, Joseph Henry, Christopher W Jones, Piers J Yates, Department of Orthopaedic Surgery, The Orthopaedic Research Foundation of Western Australia, Perth 6010, Western Australia, Australia
Matthias Wittauer, Guillermo Sánchez-Rosenberg, Faculty of Medicine, University of Basel, Basel 4001, Basel-Stadt, Switzerland
Guillermo Sánchez-Rosenberg, Department of Orthopedics and Traumatology, University Hospital Basel, Basel 4031, Basel-Stadt, Switzerland
Anton Philip Lambers, Christopher W Jones, Piers J Yates, Division of Surgery, The University of Western Australia, Perth 6009, Western Australia, Australia
Co-first authors: Matthias Wittauer and Joseph Henry.
Author contributions: Wittauer M, Henry J, Sanchez G and Lambers A contributed to conceptualization and investigation; Wittauer M and Henry J were responsible for project administration, writing – original draft, and writing – review & editing; Sanchez G and Lambers A contributed to writing – original draft; Jones C and Yates P provided supervision and contributed to writing – review & editing.
Supported by the Orthopaedic Research Foundation of Western Australia, Freie Akademische Gesellschaft Basel; and Swiss Orthopaedics.
Conflict-of-interest statement: Matthias Wittauer has nothing to disclose. Joseph Henry has nothing to disclose. Guillermo Sánchez-Rosenberg has nothing to disclose. Anton Philip Lambers has done consulting work for: DePuy Synthes and Orthobullets.com and given paid presentations for: DePuy Synthes. Christopher Jones held shares in: NavBit Pty Ltd; received royalties from: DePuy Synthes; done consulting work for: DePuy Synthes, NavBit, Enovis; given paid presentations for: DePuy Synthes, MatOrtho, Medacta, Zimmer Biomet, Enovis and received institutional support from: Johnson & Johnson, DePuy Synthes, Smith and Nephew, Stryker, Zimmer Biomet, MatOrtho, Corin, Medacta. Piers Yates held shares in: Eventum; received royalties from: Corin; done consulting work for: DePuy Synthes, MatOrtho, Enovis; given paid presentations for: DePuy Synthes, MatOrtho; received institutional support from: DePuy Synthes, Smith and Nephew, MatOrtho, Corin.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Matthias Wittauer, MD, Department of Orthopaedic Surgery, Fremantle and Fiona Stanley Hospitals, 11 Robin Warren, Perth 6150, Western Australia, Australia.
matthias.wittauer@usb.ch
Received: March 13, 2025
Revised: May 14, 2025
Accepted: July 15, 2025
Published online: August 18, 2025
Processing time: 149 Days and 1.4 Hours
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.
Core Tip: Intertrochanteric fractures are common in the older adult population and are typically treated surgically with a dynamic hip screw or an intramedullary nail with one-fifth of patients requiring reoperation. Accurate fracture reduction and optimal implant positioning are crucial for successful fracture healing and reducing reoperation rates. In this review, we examine the radiographic parameters emphasized in the current literature for assessing fracture reduction quality and implant positioning following intertrochanteric fracture fixation. This review offers orthopaedic surgeons an overview of key radiographic parameters for assessing intertrochanteric fracture fixation and enhancing risk factor identification.
