Comparison of Baumgaertner Reduction Quality criteria , Chang Criteria and AP3×ML3 Classification and Their Ability to Predict Mechanical Complications of Trochanteric Fractures Fixed with Proximal Femoral Nail

Amr Elhadidy Elhadidy, M.B.B.CH, Resident at Department of Orthopedic surgery, Faculty of Medicine, Mansoura university, Mansoura, EgyptFollow
Ahmed Abdelbadie Ibrahim, MD, Lecturer at Department of Orthopedic surgery, Faculty of Medicine, Mansoura university, Mansoura, Egypt
Sallam Ibrahim Fawzy, MD, Assistant Professor at Department of Orthopedic surgery, Faculty of Medicine, Mansoura university, Mansoura, Egypt.
Ehab Youssef Hassanin, MD, Professor at Department of Orthopedic surgery, Faculty of Medicine, Mansoura university, Mansoura, Egypt.

Subject Area

Orthopaedic Surgery

Article Type

Original Study

Abstract

Background Trochanteric fractures are common injuries among the elderly. Despite advances in fixation with proximal femoral nails (PFN), Mechanical complication remain significant. Several reduction quality systems have been proposed, but their predictive value and reproducibility remain debated. Aim To evaluate and compare the predictive value and reproducibility of Baumgaertner Reduction Quality Criteria (BRQC), Chang Reduction Quality Criteria (CRQC), and AP3×ML3 classification in patients with AO Foundation/Orthopaedic Trauma Association (AO/OTA) 31-A1 and 31-A2 trochanteric fractures fixed with PFN. Methods A prospective observational study was conducted on 146 patients with 31-A1 and A2 trochanteric fractures treated by PFN. Postoperative radiographs were assessed by three independent observers using BRQC, CRQC, and AP3×ML3. Screw placement (Cleveland zones), tip–apex distance (TAD), and calcar-referenced TAD (CalTAD) were also recorded. Primary outcomes included mechanical complications, while functional recovery was assessed by Modified Harris Hip Score (mHHS). Statistical analysis was performed using chi-square, logistic regression, and kappa/ICC reliability testing. Results Mechanical complications occurred in 10.3% of cases. Poor/acceptable BRQC, poor CRQC, and poor/moderate AP3×ML3 reductions were significantly associated with complications. Screw malposition (superior/anterior) was strongly predictive, whereas TAD and CalTAD showed no significant association. AP3×ML3 and Cleveland zones demonstrated excellent interobserver reliability, while BRQC was variable and CRQC was poor. No correlation found between mHHS and radiographic parameters. Conclusion AP3×ML3 demonstrated superior reliability and predictive accuracy compared to BRQC and CRQC. Positioning in Cleveland safe zones was critical for avoiding mechanical complications. Reduction quality strongly predicted complications, while functional recovery depended more on patient-related factors.

Recommended Citation

Elhadidy, Amr Elhadidy; Ibrahim, Ahmed Abdelbadie; Fawzy, Sallam Ibrahim; and Hassanin, Ehab Youssef (2025) "Comparison of Baumgaertner Reduction Quality criteria , Chang Criteria and AP3×ML3 Classification and Their Ability to Predict Mechanical Complications of Trochanteric Fractures Fixed with Proximal Femoral Nail," Mansoura Medical Journal: Vol. 55 : Iss. 1 , Article 7.
Available at: https://doi.org/10.58775/2735-3990.1484