BMC musculoskeletal disorders · 2026
Comparison of the predictive performance of Chang and Baumgaertner reduction quality criteria for cutout complication in geriatric unstable intertrochanteric femur fractures.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Onder Yilmaz, Bulut Tugrul, Kurtulus Tolgacan, Bahadirli Mert, Tuncez Mahmut
Аннотация
INTRODUCTION: The aim of this study was to compare the predictive performance of Baumgaertner Reduction Quality Criteria (BRQC) and Chang Reduction Quality Criteria (CRQC) for lag screw cutout in geriatric unstable intertrochanteric femur fractures treated with proximal femoral nailing (PFN).
MATERIALS AND METHODS: A retrospective study was conducted on 907 patients aged ≥ 65 years who underwent surgery for AO/OTA 31.A2 fractures between January 2018 and January 2026. Among these, 108 patients treated with the same implant (APFN) and meeting the inclusion criteria were included. To reduce the effect of known implant-position-related risk factors for cutout and thereby better isolate the predictive value of reduction quality classifications, patients with postoperative TAD values ≤ 30 mm and ≥ 20 mm and lag screws positioned center-center zone according to Cleveland were included in the study. Reduction quality was evaluated according to BRQC and CRQC using anteroposterior and lateral radiographs. Inter-system agreement was assessed using the McNemar-Bowker test and Cohen's kappa. Cutout predictive performances were compared using ROC analysis and the DeLong test. Inter- and intra-observer reliability was evaluated using weighted Cohen's kappa coefficients. A p-value < 0.05 was considered statistically significant.
RESULTS: The mean age of the patients was 79 ± 7.5 years, and 69.4% were female. 93 patients (86.1%) had bone union (non-cutout group), and 15 patients (13.9%) had cutout (cutout group). The mean bone union time was 12.54 ± 2.65 weeks. The mean time to cutout was 8.29 ± 5.52 weeks. No demographic differences were observed between groups. Both BRQC and CRQC significantly predicted cutout. However, cross-distribution and agreement analyses showed that reduction types associated with cutout were categorized into different risk groups, with CRQC demonstrating greater selectivity. ROC analysis showed AUC values of 0.79 (95% CI: 0.69-0.90) for CRQC and 0.68 (95% CI: 0.56-0.80) for BRQC, with a significant difference (ΔAUC = 0.10, p < .05). The reliability results demonstrated that CRQC exhibited consistently higher inter- and intra-observer agreement compared to BRQC.
CONCLUSION: CRQC more accurately and selectively identifies reduction types associated with cutout risk compared to BRQC. The use of CRQC can contribute to more effective intraoperative decision-making and postoperative risk stratification, especially in geriatric unstable intertrochanteric femur fractures.
MATERIALS AND METHODS: A retrospective study was conducted on 907 patients aged ≥ 65 years who underwent surgery for AO/OTA 31.A2 fractures between January 2018 and January 2026. Among these, 108 patients treated with the same implant (APFN) and meeting the inclusion criteria were included. To reduce the effect of known implant-position-related risk factors for cutout and thereby better isolate the predictive value of reduction quality classifications, patients with postoperative TAD values ≤ 30 mm and ≥ 20 mm and lag screws positioned center-center zone according to Cleveland were included in the study. Reduction quality was evaluated according to BRQC and CRQC using anteroposterior and lateral radiographs. Inter-system agreement was assessed using the McNemar-Bowker test and Cohen's kappa. Cutout predictive performances were compared using ROC analysis and the DeLong test. Inter- and intra-observer reliability was evaluated using weighted Cohen's kappa coefficients. A p-value < 0.05 was considered statistically significant.
RESULTS: The mean age of the patients was 79 ± 7.5 years, and 69.4% were female. 93 patients (86.1%) had bone union (non-cutout group), and 15 patients (13.9%) had cutout (cutout group). The mean bone union time was 12.54 ± 2.65 weeks. The mean time to cutout was 8.29 ± 5.52 weeks. No demographic differences were observed between groups. Both BRQC and CRQC significantly predicted cutout. However, cross-distribution and agreement analyses showed that reduction types associated with cutout were categorized into different risk groups, with CRQC demonstrating greater selectivity. ROC analysis showed AUC values of 0.79 (95% CI: 0.69-0.90) for CRQC and 0.68 (95% CI: 0.56-0.80) for BRQC, with a significant difference (ΔAUC = 0.10, p < .05). The reliability results demonstrated that CRQC exhibited consistently higher inter- and intra-observer agreement compared to BRQC.
CONCLUSION: CRQC more accurately and selectively identifies reduction types associated with cutout risk compared to BRQC. The use of CRQC can contribute to more effective intraoperative decision-making and postoperative risk stratification, especially in geriatric unstable intertrochanteric femur fractures.