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Reliability of lateral wall-thickness measurement in trochanteric fractures and parameters associated with lateral wall integrity Cover

Reliability of lateral wall-thickness measurement in trochanteric fractures and parameters associated with lateral wall integrity

Asian Biomedicine
Volume 18 (2024): Issue 1 (February 2024)
By: Chindarat Ratanakornphan,  Thanachart Pikulhom,  Somjet Jenvorapoj,  Chavarin Amarase and  Saran Tantavisut  
Open Access
|Mar 2024

Figures & Tables

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.
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).
(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.
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.
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.

Intra-rater reliability and inter-rater reliability of lateral wall-thickness measurement

RaterIntra-raterInter-rater
ICC95% CIICC95% CI
Rater 10.9720.963–0.9780.9440.927–0.957
Rater 20.9610.950–0.970
Rater 30.8350.792–0.870
Rater 40.8820.850–0.908

Fracture parameters for the intact and incompetent lateral wall groups

ParametersIntact (>20.5 mm)Incompetent (≤20.5 mm)P
Lateral wall thickness (mm)28.57 ± 4.8718.11 ± 3.69<0.0001
Fracture length (cm)6.51 ± 1.006.83 ± 1.590.067
Fracture angle (degree)40.35 ± 10.3235.71 ± 12.860.004
Greater trochanterNN<0.0001
involvement87 (53.05%)39 (54.17%)
Proximal64 (39.02%)11 (15.28%)
Middle13 (7.93%)22 (30.56%)
Distal
FragmentNN
Greater trochanter34280.004
Intertrochanter2531<0.0001
Lesser trochanter9461<0.0001

Univariate analysis of the odds ratio for the incompetent group

ParameterOdds ratio for incompetentP95% CI
BMI0.950.1980.880–1.027
BMD T score
Total femur0.330.020.129–0.842
Femoral neck2.270.090.877–5.864
Fracture length1.230.0750.979–1.547
Fracture angle0.960.0040.936–0.988
Greater trochanter
involvement0.380.0010.182–0.806
Middle3.78<0.00011.726–8.258
Distal
Fragment
Greater trochanter0.790.5830.341–1.832
Intertrochanter3.540.0031.539–8.133
Lesser trochanter3.120.0031.461–6.667

Demographic data for the intact and incompetent lateral wall groups

Intact (>20.5 mm)Incompetent (≤20.5 mm)P
N16472
Age (years)76.98 ± 12.9179.22 ± 12.5420.221
Range (years)24–9925–99
Gender
Male69 (42.4%)21 (29.2%)0.06
Female95 (57.6%)51 (70.8%)
Side of fracture
Right82 (50%)33 (45.8%)
Left82 (50%)39 (54.2%)
Height (cm)159.42 ± 8.67156.19 ± 8.350.461
Weight (kg)57.00 ± 12.0053.08 ± 10.720.207
BMI (kg/m2)22.32 ± 3.7621.65 ± 3.480.397
BMD (T score)
Total femur−2.26 ± 1.11−2.70 ± 0.830.055
Femoral neck−2.87 ± 1.09−3.06 ± 0.780.388

Multivariate analysis of the odds ratio for the incompetent group

ParameterOdd ratio for incompetentP95% CI
Fracture angle0.950.0010.921–0.978
Greater trochanter
involvement9.47<0.00013.517–25.475
Distal
Fragment
Intertrochanter4.49<0.00012.046–9.856
Lesser2.60.0261.12–6.036
DOI: https://doi.org/10.2478/abm-2024-0005 | Journal eISSN: 1875-855X | Journal ISSN: 1905-7415
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Language: English
Page range: 24 - 29
Published on: Mar 20, 2024
Published by: Chulalongkorn University
In partnership with: Paradigm Publishing Services
Publication frequency: 6 issues per year
Keywords:
AO/OTA classification,
fracture parameter,
hip fractures,
lateral wall thickness,
reliability
Related subjects:
Medicine,
Assistive professions, nursing,
Basic medical science,
Basic medical science, other,
Clinical medicine,
Clinical medicine, other

© 2024 Chindarat Ratanakornphan, Thanachart Pikulhom, Somjet Jenvorapoj, Chavarin Amarase, Saran Tantavisut, published by Chulalongkorn University
This work is licensed under the Creative Commons Attribution 4.0 License.

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