Traction radiographs improve evaluation of complex intertrochanteric fractures: Surgeon experience-independent effects in a nationwide simulation-based study.

Traction radiographs provide clearer visualization of fragment configuration and medial and lateral wall integrity, leading to improved recognition of fracture instability and a measurable shift toward more durable fixation strategies. Their impact on surgical planning is most pronounced in complex or borderline-unstable fracture patterns and remains consistent across experience levels. As a low-cost and readily accessible adjunct, traction radiography represents a valuable tool in the preoperative assessment of intertrochanteric fractures. Routine use is recommended, particularly when instability is suspected or when standard radiographs provide insufficient clarity.