A Modification of the Baumgaertner Reduction Quality Criteria May Increase Its Performance in Predicting Mechanical Failure After Intertrochanteric Nailing

Wednesday, October 18, 2023

11:18 AM – 11:24 AM PST

Location: 608-609

Presenting Author(s)

GG

German Garabano, MD, FIOTA (he/him/his)

Orthopaedic Surgeon
British Hospital, Buenos Aires Argentina
Asociacion Argentina Del Trauma Ortopedico
Ciudad Autonoma de Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina

Disclosure(s): No financial relationships to disclose

Corresponding Author(s)

Leonel Perez Alamino, MD

Staff Lower limb reconstruction dept of the British Hospital of Buenos Aires.
British Hospital of Buenos Aires
Ciudad Autónoma of Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina

Disclosure(s): No financial relationships to disclose

Co-Author(s)

MB

Michael R. Baumgaertner, MD
FB

Fernando Bidolegui, MD
Theodore Miclau, III, MD, FIOTA (he/him/his)

Professor and Vice Chairman
Orthopaedic Trauma Institute, Department of Orthopaedic Surgery, University of California, San Francisco (UCSF), CA, United States
San Francisco, California, United States
SP

Sebastian Pereira

Asociacion Argentina Del Trauma Ortopedico, Argentina
CP

Cesar A. Pesciallo, MD, FIOTA

Asociacion Argentina Del Trauma Ortopedico, Argentina

Purpose: The purpose of this study was to assess whether modifying the lateral plane alignment criterion from <20º to <10º of the Baumgaertner classification improved the performance of the classification in predicting failure after cephalomedullary nailing of an intertrochanteric fracture. A secondary objective was to analyze whether variables related to implant positioning were associated with failure.

Methods: Patients operated consecutively between January 2016 and January 2021 with a cephalomedullary nail for an intertrochanteric hip fracture, with a minimum follow-up of 12 months, were retrospectively analyzed. The postoperative reduction was classified according to the Baumgaertner classification and with the modified classification. The performance of each was analyzed by a comparative analysis of receiver operating characteristic (ROC) curves. Univariate and multivariate analyses were performed to identify variables associated with failure (cut-out, cut-through, nonunion).

Results: 282 patients were included. The failure rate was 10.6%. The AUC (area under the ROC curve) of the original classification was 0.66 and of the modified classification 0.78 (P = 0.023). Independent variables related to failure were analyzed, including: poor reduction of the new modified classification (odds ratio [OR] 7.81; P = 0.0001); the difference in NSA (neck-shaft angle) in AP (OR 1.22; P = 0.0003) and lateral plane (OR 1.19; P = 0.04); displacement >4 mm (OR 3.8; P = 0.006); tip to apex distance (TAD) >25 mm (OR 3.03; P = 0.005) and >21 mm (OR 3.30; P = 0.019); and TAD >21 mm + >10° in lateral plane (OR 4.70; P = 0.009).

Conclusion: The modification of the reduction criterion from <20º to <10º in the lateral alignment significantly improved the performance of the classification to predict failure. Achieving an adequate reduction in both planes and positioning the implant with a TAD <22 mm are critical to avoid failures in the treatment of intertrochanteric fractures with a cephalomedullary nail.