{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:18:49Z","timestamp":1787015929531,"version":"build-2736575974"},"reference-count":35,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,2,7]],"date-time":"2024-02-07T00:00:00Z","timestamp":1707264000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2024,3]]},"abstract":"\n Objective<\/jats:title>\n Three\u2010dimensional (3D)\u2010CT data is currently insufficient for classifying femoral trochanter fractures. Fracture classification based on fracture stability analysis is helpful to evaluate the prognosis of patients after internal fixation. Currently, there is a lack of fracture classification methods based on 3D\u2010CT images and fracture stability analysis. The aim of this study was to propose a new six\u2010part classification method for intertrochanteric fractures of femur based on 3D\u2010CT images and fracture stability analysis to improve the diagnosis rate of unstable fractures.<\/jats:p>\n <\/jats:sec>\n \n Method<\/jats:title>\n From January 2009 to December 2019, 320 patients receiving intramedullary nail surgery for femoral intertrochanteric fractures at Chengdu University's Affiliated Hospital were studied retrospectively. AO and six\u2010part classifications were undertaken according to the 3D\u2010CT image data of the patients, and the stability rates of two classifications were compared. According to the six\u2010part classification stability criteria, the patients were divided into a stable and an unstable fracture group. The perioperative and follow\u2010up indicators of the two groups were statistically analyzed, and the six\u2010part classification's inter\u2010observer and internal reliability was examined.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n There were 107 men and 213 females women the 320 patients, with an average age of 79.32\u2009\u00b1\u200911.26\u2009years and an osteoporosis rate of 55.63% (178\/320). The fracture stability rate of 39.69% (127\/320) was studied using a six\u2010part classification method. The AO classification fracture stability rate was 42.50% (136\/320), with no significant difference (\n \u03c7<\/jats:italic>\n 2<\/jats:sup>\n \u2009=\u20090.523,\n p<\/jats:italic>\n \u2009=\u20090.470\u2009>\u20090.05). There is no statistically significant difference between the two classification techniques in the examination of fracture stability (McNemer difference test\n p<\/jats:italic>\n \u2009=\u20090.306\u2009>\u20090.05; Kappa consistency test\n p<\/jats:italic>\n \u2009<\u20090.001). According to the six\u2010part classification, fracture stability and instability group were divided into two groups. The following indicators were compared between the two groups: The surgery time (\n p<\/jats:italic>\n \u2009=\u20090.280), fracture reduction quality (\n p<\/jats:italic>\n \u2009=\u20090.062); function independent measurement (\n p<\/jats:italic>\n \u2009=\u20090.075); timed up and go test (TUG) (\n p<\/jats:italic>\n \u2009=\u20090.191), and Parker\u2010Palmer score (p\u2009=\u20090.146). Were as compared according to the six\u2010part classification of stable and unstable fracture groups. Perioperative blood loss (\n p<\/jats:italic>\n \u2009<\u20090.001), the Harris score excellent and good rate (\n p<\/jats:italic>\n \u2009=\u20090.043), fracture healing time (\n p<\/jats:italic>\n \u2009<\u20090.001), and the entire weight\u2010bearing duration (\n p<\/jats:italic>\n \u2009=\u20090.002) were statistically significant. The difference in femoral head height (FHH) (\n p<\/jats:italic>\n \u2009=\u20090.046), the change in femoral neck shaft angle (\n p<\/jats:italic>\n \u2009=\u20090.003), the change in medial cephalic nail length (\n p<\/jats:italic>\n \u2009=\u20090.033), and the change in tip\u2013apex distance (TAD) (\n p<\/jats:italic>\n \u2009=\u20090.002) were statistically significant compared to the relevant markers of imaging stability. Fracture stability had a substantial influence on Harris ratings at 3, 6, and 12\u2009months following surgery, according to repeated measures analysis of variance (\n F<\/jats:italic>\n (1,126)<\/jats:sub>\n \u2009=\u200932.604,\n p<\/jats:italic>\n \u2009<\u20090.001). The effect of time on the Harris score was similarly significant (\n F<\/jats:italic>\n (1.893,238.508)<\/jats:sub>\n \u2009=\u2009202.771,\n p<\/jats:italic>\n \u2009<\u20090.001). The observer intra\u2010observer inter\u2010group correlation coefficient (ICC) value was 0.941\u2009>\u20090.75, the inter\u2010observer ICC value was 0.921\u2009>\u20090.75, and the intra\u2010observer and inter\u2010observer reliability were both good.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n The six\u2010part classification of femoral intertrochanteric fractures based on 3D\u2010CT images has broader guiding relevance for femoral intertrochanteric fracture stability analysis. Clinicians will find this classification simpler and more consistent than the AO classification.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/os.13998","type":"journal-article","created":{"date-parts":[[2024,2,7]],"date-time":"2024-02-07T22:59:13Z","timestamp":1707346753000},"page":"637-653","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Six\u2010Part Classification of Femoral Intertrochanteric Fractures: A Classification Method to Improve the Diagnosis Rate of Unstable Fractures"],"prefix":"10.1111","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7555-8779","authenticated-orcid":false,"given":"ZhengHao","family":"Wang","sequence":"first","affiliation":[{"name":"Affiliated Hospital of Chengdu University Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1353-1332","authenticated-orcid":false,"given":"KaiNan","family":"Li","sequence":"additional","affiliation":[{"name":"Affiliated Hospital of Chengdu University Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6797-3634","authenticated-orcid":false,"given":"Chao","family":"Peng","sequence":"additional","affiliation":[{"name":"Affiliated Hospital of Chengdu University Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,2,7]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2014.10.026"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2017.1032"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2474-15-188"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.16.00260"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-009-0955-0"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-012-2268-9"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.3928\/01477447-20130222-16"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/BCO.0b013e318225c410"},{"key":"e_1_2_13_10_1","article-title":"Fracture and dislocation compendium: orthopaedic trauma association committee classification, database and outcomes committee","author":"Marsh JL","year":"2007","journal-title":"J Orthop Trauma"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.34B2.333"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1949.01240030864012"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2009.10.007"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000001145"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/BTO.0000000000000130"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2015.03.007"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2016.03.009"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2014.04.016"},{"key":"e_1_2_13_19_1","doi-asserted-by":"crossref","unstructured":"MisirA OzturkK KizkapanTB YildizKI GurV SevencanA. Fracture lines and comminution zones in OTA\/AO type 23C3 distal radius fractures: The distal radius map. J Orthop Surg (Hong Kong) 2018;26:2309499017754107.","DOI":"10.1177\/2309499017754107"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-003-0586-9"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2010.03.028"},{"issue":"1","key":"e_1_2_13_22_1","first-page":"693","article-title":"Pre\u2010 and postintervention factor structure of functional independence measure in patients with spinal cord injury","volume":"2017","author":"Mikhail S","year":"2017","journal-title":"Rehabil Res Pract"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.2340\/16501977-2225"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000000713"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.75B5.8376443"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2019.03.032"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005131-201606000-00014"},{"issue":"146","key":"e_1_2_13_28_1","first-page":"53","article-title":"Mechanics of the treatment of hip injuries","volume":"146","author":"Kaufer H","year":"1980","journal-title":"Clin Orthop Relat Res"},{"key":"e_1_2_13_29_1","doi-asserted-by":"publisher","DOI":"10.12659\/MSM.913593"},{"key":"e_1_2_13_30_1","doi-asserted-by":"publisher","DOI":"10.1148\/rg.2015140301"},{"key":"e_1_2_13_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2012.09.019"},{"key":"e_1_2_13_32_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000132264.14046.c2"},{"key":"e_1_2_13_33_1","doi-asserted-by":"publisher","DOI":"10.1080\/000164701753606662"},{"key":"e_1_2_13_34_1","doi-asserted-by":"publisher","DOI":"10.1159\/000100390"},{"key":"e_1_2_13_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0020-1383(02)00089-X"},{"issue":"1","key":"e_1_2_13_36_1","first-page":"106","article-title":"Classification of hip fractures","volume":"60","author":"De Boeck H","year":"1994","journal-title":"Acta Orthop Belg"}],"container-title":["Orthopaedic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/os.13998","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,10]],"date-time":"2024-03-10T22:13:57Z","timestamp":1710108837000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/os.13998"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,7]]},"references-count":35,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024,3]]}},"alternative-id":["10.1111\/os.13998"],"URL":"https:\/\/doi.org\/10.1111\/os.13998","archive":["Portico"],"relation":{},"ISSN":["1757-7853","1757-7861"],"issn-type":[{"value":"1757-7853","type":"print"},{"value":"1757-7861","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,7]]},"assertion":[{"value":"2023-09-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-12-24","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-02-07","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}