AP3×ML3 reduction quality classification for femoral trochanteric fractures: validation for reliability focusing on positive medial cortical support

Journal of Orthopaedic Surgery and Research

Research Article

Satoshi Hatta¹  Ken Okazaki²  Yujiro Kuramitsu²  Junya Itou² 

[1] Department of Orthopaedic Surgery, Funabashi General Hospital, 1-13-1 Kitamoto-Cho, 273-0864, Funabashi, Chiba, Japan;Department of Orthopaedic Surgery, Tokyo Women’s Medical University, 8-1 Kawada-Cho, Shinjuku-Ku, 162-8666, Tokyo, Japan;

关键词: Reduction quality;    Femoral trochanteric fractures;    Positive medial cortical support;    AP3 × ML3 classification;    Baumgaertner reduction quality criteria;    Mechanical complications;   

DOI  :  10.1186/s13018-023-03555-5

 received in 2022-04-11, accepted in 2023-01-20,  发布年份 2023

来源: Springer

【 摘 要 】

IntroductionThis study evaluated the validity of the AP3 × ML3 reduction quality classification, which applies the concept of positive medial cortical support.MethodsA total of 120 trochanteric fractures classified as AO Foundation/Orthopedic Trauma Association 31A1 and A2 were retrospectively analyzed. The validity of the AP3 × ML3 classification was evaluated by comparison with the Baumgaertner reduction quality criteria. When using the AP3 × ML3 classification, reduction quality was divided into three classes based on the degree of anterior cortical contact between the proximal and distal fragments. Reduction quality was also divided into three classes when using the Baumgaertner criteria. The frequency of mechanical complications, including cut­out, delayed union, and excessive migration of the lag screw, was retrospectively assessed. Intra-observer and inter-observer reliability was assessed using the intraclass correlation coefficient (ICC).ResultsMechanical complications included 4 cases of cutout (3.3%) and 1 of delayed union (0.8%). Mechanical complications occurred for all levels of reduction quality in both classifications, except for the acceptable of the Baumgaertner criteria. When reduction quality was rated as good, acceptable, and poor the incidence of mechanical complications was 2.5%, 5.7%, and 16%, respectively, under the AP3 × ML3 classification and 3.3%, 0%, and 15.0%, respectively, under the Baumgaertner criteria. The ICC was 0.80 for intra-observer reliability and 0.57 for inter-observer reliability when using the AP3 × ML3 classification and 0.85 and 0.34, respectively, when using the Baumgaertner criteria.ConclusionThe AP3 × ML3 classification was reliable and easy to use compared with the widely used Baumgaertner reduction quality criteria.Level of evidence 4

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

Fig. 8