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

Objectives : 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 fractures 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 fractures were included in this study. The fracture in each case was assessed using a novel three-dimensional computed tomography-based three-column classification. Two examiners tested the intra and inter-observer reliability of this new classification system using kappa variance. Results : The intertrochanteric region was divided into the 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-observer kappa values were 0.91 and 0.89, while the inter-observer kappa value was 0.82, both indicating almost perfect reliability. Conclusion : This novel 3DCT-based MLP classification system for intertrochanteric fractures is comprehensive, and reproducible with good agreement. It is based on proximal femur biomechanic characteristics and traumatic mechanism, contributing to formulating more reasonable treatment protocols involving various late-model internal fixation devices.