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Objective: Determine whether preoperative AP pelvis radiographies under manual traction influence surgeon choice for implants in intertrochanteric fractures compared with standard radiographies. Methods: Fifty-eight patients with intertrochanteric fractures were prospectively enrolled from four tertiary teaching hospitals. All patients had standard AP pelvis radiographies taken as well as radiographies under manual traction of affected limb, 116 images total. Three fellowship trained trauma surgeons and three hip surgeons blindly reviewed the images and indicated their implant choice for each case: extra or intramedullary fixation. The observers received randomly assigned images and were unaware of the radiography technique, patient number, and repetition of patients within the set of images. Statistical analyses were performed using Cohen Kappa method and McNemar, Q Cochran, and Wilcoxon tests. Results: Manual traction radiographies changed surgeon-implant choice in 35.06% (range: 27.6% to 43.1%). However, traction radiographies provided no improvement in weak inter-observer reliability for treatment indication (k=0.264, p<0.001) compared to standard radiographies (k=0.220, p<0.001), when using Mann-Whitney test (p=0.359). Traction views did not increase predilection for either method. Hip surgeons agreed more than trauma surgeons concerning implant choice. Conclusions: Manual traction radiographies modified surgeon choice in up to one third of intertrochanteric fracture cases.

Radiographies under Traction Influence Surgeon Choice in Implant Selection for Intertrochanteric Fractures