Traction Internal Rotation Radiographs Aid in the Assessment of Lateral Femoral Wall Integrity in Intertrochanteric Hip Fractures

Lateral femoral wall failure may cause catastrophic collapse after fixation of intertrochanteric (IT) fractures. Traction internal rotation (TIR) radiographs may provide a more accurate fracture assessment of the lateral wall and alter the preoperative plan and fracture implant selection. Seventy-four consecutive patients with AO Foundation/Orthopaedic Trauma Association AO/ OTA 31A1-2 fractures were evaluated. Intervention was fixation of IT fractures by sliding hip screw (SHS) or cephalomedullary nail (CMN). No patient treated with a SHS had lateral wall failure at final follow-up. TIR radiographs of IT fractures can optimize preoperative evaluation of fracture morphology, particularly if an SHS is being considered. (Journal of Surgical Orthopaedic Advances 34(1):020-022, 2025)

Key words: traction internal rotation radiograph, intertrochanteric hip fracture, sliding hip screw, cephalomedullary nail, choice of implant