European validation of the Vancouver classification of periprosthetic proximal femoral fractures

Abstract

The Vancouver classification has been shown by its developers to be a valid and reliable method for categorising the configuration of periprosthetic proximal femoral fractures and for planning their management. We have re-validated this classification system independently using the radiographs of 30 patients with periprosthetic fractures. These were reviewed by six experienced consultant orthopaedic surgeons, six trainee surgeons and six medical students in order to assess intra- and interobserver reliability and reproducibility. Each observer read the radiographs on two separate occasions. The results were subjected to weighted kappa statistical analysis. The respective kappa values for interobserver agreement were 0.72 and 0.74 for consultants, 0.68 and 0.70 for trainees on the first and second readings of the radiographs and 0.61 for medical students. The intra-observer agreement for the consultants was 0.64 and 0.67, for the trainees 0.61 and 0.64, and for the medical students 0.59 and 0.60 for the first and second readings, respectively. The validity of the classification was studied by comparing the pre-operative radiological findings within B subgroups with the operative findings. This revealed agreement for 77% of these type-B fractures, with a kappa value of 0.67. Our data confirm the reliability and reproducibility of this classification system in a European setting and for inexperienced staff. This is a reliable system which can be used by non-experts, between centres and across continents.

Results of Treatment of Periprosthetic Femoral Fractures After Total Hip Arthroplasty

“…Vancouver C fractures are fractures of the femur distal to the stem. The important weakness of the Vancouver classification is the clinical difficulty in distinguishing between B1 and B2 fractures (5,7,8,21). Lindhal reported a high percentage of periprosthetic failure in type B fractures treated with plate osteosynthesis in his publications fracture; due to the limited mobility expectations of the patient, plate osteosynthesis was chosen.…”

In Brief: Classifications in Brief: Vancouver Classification of Postoperative Periprosthetic Femur Fractures

“…It has been confirmed to be reliable and valid [4,19]. One must not underscore the importance of verifying stability of the femoral component intraoperatively to properly guide treatment rationale.…”

“…Two separate studies have confirmed the reliability and validity of the Vancouver classification system, one by the Vancouver group [4], and another by Rayan et al [19]. In the study by the Vancouver group [4], six observers (three expert attending surgeons and three nonexpert fellow and senior residents) examined 40 radiographs.…”

“…Rayan et al concluded the Vancouver classification is reliable, reproducible, and valid. They also showed that substantial agreement can be attained among persons with no specialist training [19].…”

“…The European validation of the Vancouver classification system [19] consisted of 18 observers: six consultant orthopaedic surgeons specializing in joint replacement, six trainee surgeons, and six medical students. Similar to the Vancouver study, 28 radiographs were analyzed 2 weeks apart by each observer.…”