Jiantao Li1, Shaojie Tang2, Hao Zhang1, Zhirui Li1, Wanyu Deng3, Chen Zhao3, Lianghui Fan3, Guoqi Wang4, Jianheng Liu1, Peng Yin5, Gaoxiang Xu1, Licheng Zhang6, Peifu Tang7. 1. Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China. 2. School of Automation, Xi'an University of Posts and Telecommunications, Xi'an, Shanxi, 710121, China. 3. School of Computer, Xi'an University of Posts and Telecommunications, Xi'an, Shanxi, 710121, China. 4. Department of Pediatrics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing 100853, China. 5. Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gong Ren Ti Yu Chang Nan Lu Rd, Beijing 100020, China. 6. Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China. Electronic address: zhanglcheng218@126.com. 7. Department of Orthopaedics, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China. Electronic address: pftang301@163.com.
Abstract
OBJECTIVES: The aim of this study was to develop a systematic three-dimensional (3D) classification of intertrochanteric fractures by clustering the morphological features of fracture lines using the Hausdorff distance-based K-means approach and assess the usefulness of it in the clinical setting. METHODS: We retrospectively analyzed the data of 504 patients with intertrochanteric fractures who underwent closed reduction and intramedullary internal fixation. The morphological fracture lines of all patients extracted from computed tomography were transcribed freehand onto the template. All fracture lines were then clustered into five distinct types using the Hausdorff distance-based K-means clustering method. Five radiographic parameters and four functional parameters were used to evaluate the postoperative functional states and mobilization levels. Postoperative complications were also recorded. RESULTS: Intertrochanteric fractures were classified into five types: type I (108/504, 21.4%), simple fracture with intact lateral femoral wall and greater trochanter fragment; type II (85/504, 16.9%), simple fracture with intact lateral femoral wall with/without lesser trochanter detachment; type III (147/504, 29.2%), fractures with intertrochanteric crest detachment involving the lesser trochanter and greater trochanter with an intact lateral femoral wall; type IV (113/504, 22.4%), fractures with large intertrochanteric crest detachment and large lesser trochanter and greater trochanter detachment partially involving the lateral femoral wall and less medial cortical support; type V (51/504, 10.1%), a combination of pertrochanteric and lateral fracture line involving the entire lateral femoral wall and lesser trochanter detachment. Parameters of femoral neck-shaft angle and sliding distance of the cephalic nail were significantly different among types. The complication rate generally increased from type I to type V (P = 0.035). CONCLUSIONS: The unsupervised clustering can achieve identification of the type of intertrochanteric fractures with clinical significance. The Tang classification can be used to describe fracture morphology, predict the possibility of achieving stable reduction and the risk of complications following intramedullary fixation.
OBJECTIVES: The aim of this study was to develop a systematic three-dimensional (3D) classification of intertrochanteric fractures by clustering the morphological features of fracture lines using the Hausdorff distance-based K-means approach and assess the usefulness of it in the clinical setting. METHODS: We retrospectively analyzed the data of 504 patients with intertrochanteric fractures who underwent closed reduction and intramedullary internal fixation. The morphological fracture lines of all patients extracted from computed tomography were transcribed freehand onto the template. All fracture lines were then clustered into five distinct types using the Hausdorff distance-based K-means clustering method. Five radiographic parameters and four functional parameters were used to evaluate the postoperative functional states and mobilization levels. Postoperative complications were also recorded. RESULTS: Intertrochanteric fractures were classified into five types: type I (108/504, 21.4%), simple fracture with intact lateral femoral wall and greater trochanter fragment; type II (85/504, 16.9%), simple fracture with intact lateral femoral wall with/without lesser trochanter detachment; type III (147/504, 29.2%), fractures with intertrochanteric crest detachment involving the lesser trochanter and greater trochanter with an intact lateral femoral wall; type IV (113/504, 22.4%), fractures with large intertrochanteric crest detachment and large lesser trochanter and greater trochanter detachment partially involving the lateral femoral wall and less medial cortical support; type V (51/504, 10.1%), a combination of pertrochanteric and lateral fracture line involving the entire lateral femoral wall and lesser trochanter detachment. Parameters of femoral neck-shaft angle and sliding distance of the cephalic nail were significantly different among types. The complication rate generally increased from type I to type V (P = 0.035). CONCLUSIONS: The unsupervised clustering can achieve identification of the type of intertrochanteric fractures with clinical significance. The Tang classification can be used to describe fracture morphology, predict the possibility of achieving stable reduction and the risk of complications following intramedullary fixation.
Authors: Hong-Li Deng; Yu-Xuan Cong; Hai Huang; Bin-Fei Zhang; Ya-Hui Fu; Jin-Lai Lei; Hu Wang; Peng-Fei Wang; Yan Zhuang; Chao Ke Journal: Biomed Res Int Date: 2021-08-09 Impact factor: 3.411