Classification of trochanteric fracture of the proximal femur: a study of the reliability of current systems

High reliability of an algorithm for choice of implants in hip fracture patients

“…Based on well-known classifications, the five different implant types in the algorithm are easily chosen. The simplicity of grouping into fewer choices also improves agreement, as shown in previous studies of the Garden and AO/OTA classifications [5][6][7][8]. The main disagreements in the algorithm were seen among vertical, basocervical and A1.1 trochanteric fractures [3,[9][10][11][12].…”

“…1) was proposed for standardizing hip fracture surgery between surgeons and hospitals [1]. This study shows that although the algorithm relies on the commonly used, only moderately reliable, fracture classifications, implants were chosen with an almost perfect agreement between observers [2][3][4][5][6][7][8]. Also, the new measurement for posterior tilt [13] revealed to be both assessable and reliable, with doubt regarding subsequent algorithm choice of implant type occurring in only two patients.…”

“…However, previous studies have shown the Garden classification to have only a fair reliability, improving to moderate if simply dividing into undisplaced or displaced fracture groups [5]. Also, the AO/OTA classification for trochanteric fractures has shown only a fair reliability, improving to substantial if using the three main groups only [6][7][8]. Classifying into vertical and basocervical fractures among all types of hip fractures has not previously been evaluated, but the vertical fracture could be seen as the third of the three types in the Pauwel classification, which shows only fair reliability [9][10][11][12].…”

“…1), which standardizes choice of implant type, has been shown to reduce reoperation rates [1]. The algorithm is, however, based on the commonly used fracture classification systems, primarily the Garden classification [2], of femoral-neck fractures and the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classification [3] of trochanteric fractures; both previously evaluated to have only a fair to moderate reliability [4][5][6][7][8].…”

Modified Double Tension Band Wiring for Reattaching the Greater Trochanter When Performing Hemiarthroplasty for Intertrochanteric Fracture in Elderly Patients

“…Cable을 이용하는 방법의 경우는 고정력 이 강하다는 장점이 있고 비교적 큰 골편의 고정에 용이하 나, 골다공증과 분쇄가 심한 경우에는 적용하기 어렵다는 단점이 있다 16,20) . (Table 1) 18) .…”