Preoperative radiographic features of trochanteric fractures irreducible by closed reduction

•The feasibility of obtaining a successful closed reduction is predicted by the preoperative imaging findings.•The direction of displacement of the head-neck fragment and the fracture pattern of the lesser and greater trochanters are important.•Preoperative identification of irreducible cases should help surgeons avoid unnecessary fracture manipulation.•The in-operating-room time could be reduced by the preoperative prediction. The aim of this study was to clarify the relationship between the preoperative radiographic classification of trochanteric fractures and the success/failure of closed reduction. Identification of irreducible fractures would be important to proceed promptly to direct reduction. Our retrospective analysis included 141 trochanteric fractures, in 122 women and 17 men, with a mean age of 85.7 years (range, 45–101 years). Evans’ classification of trochanteric fractures, as modified by Jensen, and the lateral view classification were used, based on preoperative plain radiographs and computed tomography images. Features predictive of irreducible fractures were identified. Among the 141 fractures, 16 (11.3%) were irreducible by closed reduction. The position of the proximal fragment, relative to the shaft on lateral view, and the fracture pattern of the lesser and greater trochanters were predictive of the feasibility of obtaining a successful closed reduction. These criteria identified success/failure of closed reduction in 99.3% of cases. Our findings should be useful for identifying patients in whom closed reduction would be suitable and for avoiding ineffectual manipulation in unsuitable patients.