Assessment of the AO classification of intracapsular fractures of the proximal femur

Abstract

There are a number of classification systems for intracapsular fractures of the proximal femur, but none has been shown to be practical with satisfactory reproducibility and accurate predictive value. We have investigated the AO classification and evaluated intra- and interobserver accuracy and its value in predicting treatment and outcome. We found it to have very poor intra- and interobserver reliability and to be of limited predictive use for the outcome of treatment. A simplified system in which the subdivisions were allocated to one of three groups of undisplaced, displaced and basal fractures was found to be of value. We conclude that this is the only division which is appropriate for these fractures and that the AO system for intracapsular fractures is too complicated and should not be used.

Radiographic union score for hip substantially improves agreement between surgeons and radiologists

“…Other studies of interest to us are those that assess reviewer agreement on fracture classification systems using radiographs [23-25]. A test of the AO classification system using plain radiographs yielded poor agreement [23].…”

“…A test of the AO classification system using plain radiographs yielded poor agreement [23]. Eight observers assessing fractures radiographically using Garden’s classification system also had low agreement [24].…”

More reoperations for periprosthetic fracture after cemented hemiarthroplasty with polished taper-slip stems than after anatomical and straight stems in the treatment of hip fractures

“…The Pauwels (43) and AO classifications (44) are also described in current literature, but Pauwels classification has been found unreliable (45) and the AO classification is too complicated and has poor intra-and inter-observer accuracy (46). These classifications are not frequently used.…”

Was bleibt von der Frakturklassifikation nach Pauwels? Eine kritische Literaturanalyse

“…Insgesamt werden mit den Untergruppen 12 Frakturformen unterschieden und es gehen sowohl Bruchtyp als auch der Dislokationsgrad in die Beurteilung ein. Die Intra-und Interobserver-Variabilität dieser Klassifikation ist jedoch so hoch, dass sie für zu kompliziert für den praktischen Gebrauch gehalten wird [4]. Wie schon Böhler [6] vor Jahrzehnten festgestellt hat, empfehlen Blundell et al [4] eine vereinfachte Klassifikation, in der nur zwischen dislozierten und undislozierten sowie basalen Frakturen unterschieden wird.…”

“…Manninger et al [27] sehen durch die Berücksichtigung der Frakturneigung keine Hilfe bei der Therapieauswahl. Der Versuch, mittels komplexer Einteilungen wie jener der AO [28], unter Berücksichtigung von Frakturform und Dislokation prognostische Aussagen zu treffen, ist nicht gelungen [4].…”