Abstract

Background
Anteromedial cortical support (AMCS) improves mechanical stability in intertrochanteric femur fractures, but a reproducible, CT-validated approach to reliably achieve AMCS is lacking. We validated a percutaneous anterior leverage technique using computed tomography (CT).
Methods
We retrospectively reviewed patients treated by a single surgeon in Korea between March 2022 and December 2024. Inclusion criteria were AO/OTA A1–A3 fractures, application of the leverage technique, preoperative and postoperative CT scans, and at least 6 months of follow-up. AMCS was assessed on CT as anterior support on axial images and medial support on coronal images, each graded as positive, neutral, or negative. Outcomes included time to union, union rate, change in neck-shaft angle, and treatment failure. Risk factors for failure were explored.
Results
Of 273 patients screened, 53 met inclusion criteria. Follow-up was at least 6 months in all cases. Positive anterior support was achieved in 37 patients (69.8%) and positive medial support in 42 (79.2%). No patient demonstrated negative anterior support; one (1.9%) had negative medial support. Cortical support improved significantly after surgery (anterior P=0.026; medial P=0.001). Union occurred in 50 patients (96.2%) at 3.93±1.48 months. Mean varus change in neck-shaft angle at final follow-up was 1.75°±2.34°. Treatment failure occurred in three patients (5.7%). Anteromedial cortical breakage during follow-up differed between failure and non-failure groups (P=0.002), but regression identified no independent predictors. No technique-related complications were observed.
Conclusions
Percutaneous anterior leverage produced favorable CT-confirmed AMCS and high union with low failure, supporting its safety and effectiveness in intertrochanteric femur fractures. Level of evidence: IV.

• Keywords: Hip fractures; X-ray computed tomography; Internal fracture fixation; Aged