By means of Kappa statistics, we calculated the inter- and intra-observer variation in the classification of fractures of the neck of the femur according to Garden's system. Radiographs of 96 consecutive patients were assessed independently by six observers who agreed on classification for only 14 fractures (15%). The level of agreement was poor for the overall classification (Kappa = 0.39). When reducing Garden's system into non-displaced (Stage I and II) and displaced fractures (Stage III and IV) the level of agreement became acceptable (Kappa = 0.68). However, problems remain in distinguishing Stage II and Stage III fractures, and further improvements in the classification system are necessary.
During a 10 year period 58 patients had 80 trigger fingers operated on at this hospital. The male/female ratio was 32:26 and most children were operated on at between the ages of 2 and 4 years, and 15 months (range 2-99) after the lesion had been noticed. The operation was quick and effective with no complications. Only one patient was re-operated on, with a good result. Thirteen patients had bilateral lesions. Both hands were examined and in 11 patients (19%) we found that the thickening corresponding to the trigger finger was also present on the opposite side but giving no symptoms. There seems to be a predisposition to bilateral affections.
We describe a patient in whom the motor branch to the first dorsal interosseous muscle was injured by the pins of an fixator used to treat an unstable fracture of the distal radius. She was successfully treated by extensor indicis proprius transfer to the base of the proximal phalanx of the index finger.
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