{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T04:50:33Z","timestamp":1782190233176,"version":"3.54.5"},"reference-count":36,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JFMK"],"abstract":"<jats:p>Lateral femoral neck and peritrochanteric fractures are common and clinically challenging injuries, particularly in the elderly population, with significant implications for morbidity, mortality, and functional recovery. Traditional classification systems are widely used to guide treatment, yet their reproducibility and clinical applicability remain debated. Increasing attention has been directed toward trabecular architecture and its role in fracture behavior and reduction strategies. This review aims to summarize current evidence on classification systems, trabecular-based fracture patterns, pre-operative reduction techniques, and fixation strategies. A narrative review was conducted using PubMed\/MEDLINE, Embase, and Scopus databases up to May 2026. Original studies, reviews, and biomechanical investigations focusing on proximal femur fracture classification, reliability, trabecular alignment, reduction techniques, and fixation methods were included. Data were qualitatively analyzed, with emphasis on interobserver reliability, biomechanical implications, and clinical outcomes. Conventional classification systems, including anatomical, Evans\u2013Jensen, and AO\/OTA frameworks, demonstrated variable and generally moderate reproducibility, with reported interobserver agreement ranging from approximately \u03ba = 0.30 to 0.60. Emerging evidence highlights the importance of trabecular architecture, distinguishing intradigital fractures\u2014confined within trabecular pathways and relatively stable\u2014from extradigital fractures, which disrupt load-bearing structures and are associated with increased mechanical instability and higher failure rates. Biomechanical and clinical studies indicate that inadequate reduction with trabecular misalignment significantly increases the risk of varus collapse and implant cut-out. Reduction strategies tailored to fracture pattern, such as internal rotation for intradigital fractures and external or combined maneuvers for extradigital patterns, improve alignment and load transfer. In terms of fixation, dynamic hip screws remain effective in stable fractures, whereas cephalomedullary nails demonstrate superior performance in unstable patterns, with lower reoperation rates reported (approximately 5\u20138% vs. 10\u201315%). Management of lateral femoral neck and peritrochanteric fractures should extend beyond traditional classification systems to incorporate trabecular biomechanics. Restoration of trabecular alignment, alongside established parameters such as neck\u2013shaft angle and tip\u2013apex distance, is critical for optimizing outcomes. Further prospective studies are needed to validate trabecular-based classifications and standardize reduction strategies.<\/jats:p>","DOI":"10.3390\/jfmk11020241","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T15:11:22Z","timestamp":1781709082000},"page":"241","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Lateral Femoral Neck and Peritrochanteric Fractures: Anatomical Classifications and Pre-Operative Reduction Techniques\u2014A Narrative Review"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-9565-6691","authenticated-orcid":false,"given":"Giacomo","family":"Capece","sequence":"first","affiliation":[{"name":"U.O.C. Orthopedics and Traumatology, Ospedale dei Pellegrini, 80134 Naples, Italy"},{"name":"Department of Ageing, Neurosciences, Head-Neck and Orthopaedics Sciences, Orthopaedics and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerardo","family":"Giudice","sequence":"additional","affiliation":[{"name":"U.O.C. Orthopedics and Traumatology, Ospedale dei Pellegrini, 80134 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruggiero","family":"Giliberti","sequence":"additional","affiliation":[{"name":"U.O.C. Orthopedics and Traumatology, Ospedale dei Pellegrini, 80134 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierluigi","family":"Di Cosmo","sequence":"additional","affiliation":[{"name":"U.O.C. Orthopedics and Traumatology, Ospedale dei Pellegrini, 80134 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Pizzi","sequence":"additional","affiliation":[{"name":"U.O.C. Orthopedics and Traumatology, Ospedale dei Pellegrini, 80134 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Lepore","sequence":"additional","affiliation":[{"name":"Department of Public Health, University of Naples Federico II, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7860-8499","authenticated-orcid":false,"given":"Rosario Junior","family":"Sagliocco","sequence":"additional","affiliation":[{"name":"U.O.C. Orthopedics and Traumatology, Ospedale dei Pellegrini, 80134 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Cuozzo","sequence":"additional","affiliation":[{"name":"U.O.C. Orthopedics and Traumatology, Ospedale dei Pellegrini, 80134 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emidio","family":"Di Gialleonardo","sequence":"additional","affiliation":[{"name":"Department of Ageing, Neurosciences, Head-Neck and Orthopaedics Sciences, Orthopaedics and Trauma Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Gison","sequence":"additional","affiliation":[{"name":"U.O.C. Orthopedics and Traumatology, Ospedale dei Pellegrini, 80134 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.jcot.2012.04.001","article-title":"Proximal femoral fractures: Principles of management and review of literature","volume":"3","author":"Mittal","year":"2012","journal-title":"J. Clin. Orthop. Trauma"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1007\/s00590-023-03664-1","article-title":"Epidemiology of proximal femur fractures in the young population of Qatar","volume":"34","author":"Hantouly","year":"2024","journal-title":"Eur. J. Orthop. Surg. 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