Journal of orthopaedic surgery and research · 2026
Concordance of surgical treatment with AO/OTA subclassification in intertrochanteric femoral fractures.
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Topkaya Yüksel, Zhamilov Vadym, Uslu Özgür, Özdemir Yunus Emre, Arslan Ali, Kocadağ Doğuş Turgut, Emir Büşra
Аннотация
BACKGROUND: This study aimed to evaluate the association between AO/OTA subclassification and treatment selection in intertrochanteric femur fractures and to determine how closely real-world clinical decisions align with classification-based recommendations.
METHODS: A retrospective analysis was performed on 474 patients treated for intertrochanteric femur fractures between 2015 and 2020. Fractures were subclassified according to AO/OTA 31-A classification using standard radiographs. Chi-square tests with Cramer's V were used to assess the relationship between fracture groups and treatment modalities. Multinomial logistic regression evaluated predictors of treatment choice, while guideline adherence was analyzed using binary logistic regression. A p value < 0.05 was considered statistically significant.
RESULTS: PFN was the most frequently applied treatment (74.1%), followed by conservative management (13.5%) and DHS (5.7%). Treatment distribution differed significantly among AO/OTA groups (χ2 = 40.408, p < 0.001; Cramer's V = 0.206). AO/OTA group independently predicted treatment selection (p = 0.002), whereas age (p = 0.179) and sex (p = 0.579) did not independently predict treatment selection. The regression model explained 8-10% of treatment variance (Nagelkerke R2 = 0.097). Guideline adherence was 79.3%, with no independent predictors of non-adherence. Additionally, the 95% confidence intervals for regression coefficients crossed 1 for all variables (age: 0.947-1.016; sex: 0.570-1.483; AO group: 0.592-1.199), confirming that none independently predicted adherence. Conservative treatment was relatively frequent due to the cohort's advanced age and comorbidity burden. Revision surgery occurred in 3.8% of cases.
CONCLUSIONS: Although AO/OTA subclassification significantly influences treatment choice, fracture morphology alone is insufficient for determining management. PFN remains preferred across fracture types, while non-operative care is suitable for high-risk patients. Future models should integrate frailty, bone quality, and functional status.
METHODS: A retrospective analysis was performed on 474 patients treated for intertrochanteric femur fractures between 2015 and 2020. Fractures were subclassified according to AO/OTA 31-A classification using standard radiographs. Chi-square tests with Cramer's V were used to assess the relationship between fracture groups and treatment modalities. Multinomial logistic regression evaluated predictors of treatment choice, while guideline adherence was analyzed using binary logistic regression. A p value < 0.05 was considered statistically significant.
RESULTS: PFN was the most frequently applied treatment (74.1%), followed by conservative management (13.5%) and DHS (5.7%). Treatment distribution differed significantly among AO/OTA groups (χ2 = 40.408, p < 0.001; Cramer's V = 0.206). AO/OTA group independently predicted treatment selection (p = 0.002), whereas age (p = 0.179) and sex (p = 0.579) did not independently predict treatment selection. The regression model explained 8-10% of treatment variance (Nagelkerke R2 = 0.097). Guideline adherence was 79.3%, with no independent predictors of non-adherence. Additionally, the 95% confidence intervals for regression coefficients crossed 1 for all variables (age: 0.947-1.016; sex: 0.570-1.483; AO group: 0.592-1.199), confirming that none independently predicted adherence. Conservative treatment was relatively frequent due to the cohort's advanced age and comorbidity burden. Revision surgery occurred in 3.8% of cases.
CONCLUSIONS: Although AO/OTA subclassification significantly influences treatment choice, fracture morphology alone is insufficient for determining management. PFN remains preferred across fracture types, while non-operative care is suitable for high-risk patients. Future models should integrate frailty, bone quality, and functional status.