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

Chindarat Ratanakornphan
Chindarat Ratanakornphan
, 
Thanachart Pikulhom
Thanachart Pikulhom
, 
Somjet Jenvorapoj
Somjet Jenvorapoj
, 
Chavarin Amarase
Chavarin Amarase
 y 
Saran Tantavisut
Saran Tantavisut
   | 20 mar 2024
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Article Category: Brief Communication
Publicado en línea: 20 mar 2024
Páginas: 24 - 29
DOI: https://doi.org/10.2478/abm-2024-0005
Palabras clave
© 2024 Chindarat Ratanakornphan et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

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

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

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

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

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

Multivariate analysis of the odds ratio for the incompetent group

Parameter Odd ratio for incompetent P 95% CI
Fracture angle 0.95 0.001 0.921–0.978
Greater trochanter
involvement 9.47 <0.0001 3.517–25.475
Distal
Fragment
Intertrochanter 4.49 <0.0001 2.046–9.856
Lesser 2.6 0.026 1.12–6.036
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