Three-Dimensional Computed Tomographic Analysis for Comminution of Pertrochanteric Femoral Fracture: Comminuted Anterior Cortex as a Predictor of Cutting Out

Sachiyuki Tsukada1, *, Motohiro Wakui1, Hiroshi Yoshizawa1, Masunao Miyao1, Takeshi Honma2
1 Department of Orthopaedic Surgery, Nekoyama Miyao Hospital, Niigata, Japan
2 Department of Rehabilitation, Nekoyama Miyao Hospital, Niigata, Japan

Article Metrics

CrossRef Citations:
Total Statistics:

Full-Text HTML Views: 864
Abstract HTML Views: 421
PDF Downloads: 313
ePub Downloads: 229
Total Views/Downloads: 1827
Unique Statistics:

Full-Text HTML Views: 519
Abstract HTML Views: 273
PDF Downloads: 220
ePub Downloads: 173
Total Views/Downloads: 1185

Creative Commons License
© Tsukada et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (, which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Orthopaedic Surgery, Nekoyama Miyao Hospital, 14-7 Konan, Chūō-ku, Niigata, 950-1151, Japan; Tel: +81-25-282-2323; Fax: +81-25-281-7331; Email:



Fixed angle sliding hip screw devices allow controlled impaction between the head neck fragment and the femoral shaft fragment in the surgical treatment of pertrochanteric fractures. This study was performed to evaluate the frequency and pattern of comminution at the fracture site, which may prevent the intended impaction.

Materials and Methods:

Three-dimensional computed tomography was used to investigate 101 pertrochanteric fractures treated with fixed angle sliding hip screw devices, with emphasis on the comminuted cortex. A comminuted fracture was defined as a fracture that had a third fracture fragment at the main fracture line.


There were 40 fractures without comminution and 61 with comminution. All 61 comminuted fractures had a comminuted posterior cortex, and 3 of 61 fractures also had comminution at the anterior cortex. The prevalence of cutting out of the implant from the femoral head was significantly higher in cases involving comminution at both the posterior and anterior cortices than in cases involving comminution only at the posterior cortex (66.7 % and 3.4 %, p < 0.0001).


The posterior cortex was comminuted in 60.4% of pertrochanteric fractures and the anterior cortex in 3.0%. Intended impaction at the fracture site could not be obtained at any cortex in cases with comminution at both the anterior and posterior cortices; comminution at the anterior cortex may be a predictor of cutting out.

Keywords: Cut out, hip fracture, nakano classification, osteoporosis, radiology, trochanteric.