Figure 1.
Illustration of the lateral wall-thickness measurement (d). It is defined as the distance in millimeter (mm) from a reference point that is located 3 cm below the innominate tubercle of the greater trochanter and angled at 135° upward to the midline between the two cortices of the fracture.
Figure 2.
(A) Illustration of the fracture length (L), (B) fracture angle (θ), and (C) the greater trochanter involvement (proximal, middle, and distal).
Figure 3.
Patients with AO 31A1.3 classification intertrochanteric fracture. Lateral wall thickness = 26.34 mm, Fracture length = 6.02 cm, Fracture angle = 47°, Greater trochanter involvement at middle one–third, Fragment at lesser trochanter.
Figure 4.
Patient with AO 31A2.3 classification intertrochanteric fracture (lateral wall incompetence). Lateral wall thickness = 14.22 mm. Fracture length = 8.01 cm. Fracture angle = 22°. Greater trochanter involvement at distal one-third, Fragment at greater and lesser trochanters.
Table 1.
Demographic data for the intact and incompetent lateral wall groups
| Intact (>20.5 mm) | Incompetent (≤20.5 mm) | P | |
|---|---|---|---|
| N | 164 | 72 | |
| Age (years) | 76.98 ± 12.91 | 79.22 ± 12.542 | 0.221 |
| Range (years) | 24–99 | 25–99 | |
| Gender | |||
| Male | 69 (42.4%) | 21 (29.2%) | 0.06 |
| Female | 95 (57.6%) | 51 (70.8%) | |
| Side of fracture | |||
| Right | 82 (50%) | 33 (45.8%) | |
| Left | 82 (50%) | 39 (54.2%) | |
| Height (cm) | 159.42 ± 8.67 | 156.19 ± 8.35 | 0.461 |
| Weight (kg) | 57.00 ± 12.00 | 53.08 ± 10.72 | 0.207 |
| BMI (kg/m2) | 22.32 ± 3.76 | 21.65 ± 3.48 | 0.397 |
| BMD (T score) | |||
| Total femur | −2.26 ± 1.11 | −2.70 ± 0.83 | 0.055 |
| Femoral neck | −2.87 ± 1.09 | −3.06 ± 0.78 | 0.388 |
Table 2.
Fracture parameters for the intact and incompetent lateral wall groups
| Parameters | Intact (>20.5 mm) | Incompetent (≤20.5 mm) | P |
|---|---|---|---|
| Lateral wall thickness (mm) | 28.57 ± 4.87 | 18.11 ± 3.69 | <0.0001 |
| Fracture length (cm) | 6.51 ± 1.00 | 6.83 ± 1.59 | 0.067 |
| Fracture angle (degree) | 40.35 ± 10.32 | 35.71 ± 12.86 | 0.004 |
| Greater trochanter | N | N | <0.0001 |
| involvement | 87 (53.05%) | 39 (54.17%) | |
| Proximal | 64 (39.02%) | 11 (15.28%) | |
| Middle | 13 (7.93%) | 22 (30.56%) | |
| Distal | |||
| Fragment | N | N | |
| Greater trochanter | 34 | 28 | 0.004 |
| Intertrochanter | 25 | 31 | <0.0001 |
| Lesser trochanter | 94 | 61 | <0.0001 |
Table 3.
Intra-rater reliability and inter-rater reliability of lateral wall-thickness measurement
| Rater | Intra-rater | Inter-rater | ||
|---|---|---|---|---|
| ICC | 95% CI | ICC | 95% CI | |
| Rater 1 | 0.972 | 0.963–0.978 | 0.944 | 0.927–0.957 |
| Rater 2 | 0.961 | 0.950–0.970 | ||
| Rater 3 | 0.835 | 0.792–0.870 | ||
| Rater 4 | 0.882 | 0.850–0.908 | ||
[i] ICC, Intra-class correlation coefficient.
Table 4.
Univariate analysis of the odds ratio for the incompetent group
| Parameter | Odds ratio for incompetent | P | 95% CI |
|---|---|---|---|
| BMI | 0.95 | 0.198 | 0.880–1.027 |
| BMD T score | |||
| Total femur | 0.33 | 0.02 | 0.129–0.842 |
| Femoral neck | 2.27 | 0.09 | 0.877–5.864 |
| Fracture length | 1.23 | 0.075 | 0.979–1.547 |
| Fracture angle | 0.96 | 0.004 | 0.936–0.988 |
| Greater trochanter | |||
| involvement | 0.38 | 0.001 | 0.182–0.806 |
| Middle | 3.78 | <0.0001 | 1.726–8.258 |
| Distal | |||
| Fragment | |||
| Greater trochanter | 0.79 | 0.583 | 0.341–1.832 |
| Intertrochanter | 3.54 | 0.003 | 1.539–8.133 |
| Lesser trochanter | 3.12 | 0.003 | 1.461–6.667 |