Fracture line distribution in femoral head fractures: a complement to Pipkin, Brumback, and AO/OTA classifications

Wu, Sen; Li, Ruiyang; Wei, Wang; Zhang, Yingqi; Mei, Jiong

doi:10.1007/s11547-022-01558-6

Cited by 1 publication

(8 citation statements)

References 18 publications

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“…Observers 2, 3, and 4 (GQ, BD, and QQZ) have been specialists in orthopaedic surgery for 17, 15, and 15 years, respectively. The classification was conducted according to the Pipkin [8], Brumback [1], AO/OTA [5], Chiron [2], and New classifications [9]. All patients' fractures were classified by the four observers separately.…”

Section: Examination Processmentioning

confidence: 99%

“…The most challenging part of the Chiron classification was describing the fragment size. In addition, the greatest challenges in using the New classification were to distinguish between subtypes B1 and C. In the New classification, the fracture lines of Type B1 were distributed in the central part of the femoral head, while Type C was in the superior-inferior part [9]. However, most fragments of subtype C were also cut parallel along the axis of the pressure trabecular bone, similar to Type B1 [9].…”

Section: Interobserver and Intraobserver Reproducibility Of Classific...mentioning

confidence: 99%

“…In addition, the greatest challenges in using the New classification were to distinguish between subtypes B1 and C. In the New classification, the fracture lines of Type B1 were distributed in the central part of the femoral head, while Type C was in the superior-inferior part [9]. However, most fragments of subtype C were also cut parallel along the axis of the pressure trabecular bone, similar to Type B1 [9]. Thus, subtypes B1 and C were similar, because there was no obvious anatomic landmark on the femoral head that could be used to differentiate these two subtypes.…”

Section: Interobserver and Intraobserver Reproducibility Of Classific...mentioning

confidence: 99%

“…Classifying these injuries is important, because a widely applicable classification (one that can successfully classify most or nearly all such injuries) that has a high degree of interobserver and intraobserver reproducibility would facilitate treatment recommendations, help surgeons to estimate patients' prognoses with precision, allow physicians and clinician-scientists to communicate clearly with one another, and enable comparative research. Classifications that lack reliability have the opposite effects, and some classifications may be reliable but not universal-that is, they may not be able to capture the variety and nuance of different fracture types [9].…”

Section: Introductionmentioning

confidence: 99%

“…To our knowledge, five classification systems for these injuries are commonly used: Pipkin [8], Brumback [1], AO/Orthopaedic Trauma Association (OTA) [5], Chiron [2], and New [9], but none has emerged as clearly superior to any other, and studying this problem is challenging because of the rarity of these injuries [6]. Although the Pipkin classification has been most commonly used in past decades, the overall prognosis of its subtypes, except Pipkin III, remains controversial [6].…”

Section: Introductionmentioning

confidence: 99%

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Clinical Evaluation of Femoral Head Fractures: Which Classification Systems Have the Best Universality, Reliability, and Reproducibility?

Qian

Huang

et al. 2023

Clin Orthop Relat Res

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BackgroundFemoral head fractures are rare but potentially disabling injuries, and classifying them accurately and consistently can help surgeons make good choices about their treatment. However, there is no consensus as to which classification of these fractures is the most advantageous; parameters that might inform this choice include universality (the proportion of fractures that can be classified), as well as, of course, interobserver and intraobserver reproducibility.Questions/purposes(1) Which classification achieves the best universality (defined as the proportion of fractures that can be classified)? (2) Which classification delivers the highest intraobserver and interobserver reproducibility in the clinical CT assessment of femoral head fractures? (3) Based on the answers to those two questions, which classifications are the most applicable for clinical practice and research?MethodsBetween January 2011 and January 2023, 254 patients with femoral head fractures who had CT scans (CT is routine at our institution for patients who have experienced severe hip trauma) were potentially eligible for inclusion in this study, which was performed at a large Level I trauma center in China. Of those, 9% (23 patients) were excluded because of poor-quality CT images, unclosed physes, pathologic fractures, or acetabular dysplasia, leaving 91% (231 patients with 231 hips) for analysis here. Among those, 19% (45) were female. At the time of injury, the mean age was 40 ± 17 years. All fractures were independently classified by four observers according to the Pipkin, Brumback, AO/Orthopaedic Trauma Association (OTA), Chiron, and New classifications. Each observer repeated his classifications again 1 month later to allow us to ascertain intraobserver reliability. To evaluate the universality of classifications, we characterized the percentage of hips that could be classified using the definitions offered in each classification. The kappa (κ) value was calculated to determine interrater and intrarater agreement. We then compared the classifications based on the combination of universality and interobserver and intraobserver reproducibility to determine which classifications might be recommended for clinical and research use.ResultsThe universalities of the classifications were 99% (228 of 231, Pipkin), 43% (99 of 231, Brumback), 94% (216 of 231, AO/OTA), 99% (228 of 231, Chiron), and 100% (231 of 231, New). The interrater agreement was judged as almost perfect (κ 0.81 [95% CI 0.78 to 0.84], Pipkin), moderate (κ 0.51 [95% CI 0.44 to 0.59], Brumback), fair (κ 0.28 [95% CI 0.18 to 0.38], AO/OTA), substantial (κ 0.79 [95% CI 0.76 to 0.82], Chiron), and substantial (κ 0.63 [95% CI 0.58 to 0.68], New). In addition, the intrarater agreement was judged as almost perfect (κ 0.89 [95% CI 0.83 to 0.96]), substantial (κ 0.72 [95% CI 0.69 to 0.75]), moderate (κ 0.51 [95% CI 0.43 to 0.58]), almost perfect (κ 0.87 [95% CI 0.82 to 0.91]), and substantial (κ 0.78 [95% CI 0.59 to 0.97]), respectively. Based on these findings, we determin...

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Section: Examination Processmentioning

confidence: 99%

Section: Interobserver and Intraobserver Reproducibility Of Classific...mentioning

confidence: 99%

Section: Interobserver and Intraobserver Reproducibility Of Classific...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Clinical Evaluation of Femoral Head Fractures: Which Classification Systems Have the Best Universality, Reliability, and Reproducibility?

Qian

Huang

et al. 2023

Clin Orthop Relat Res

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show abstract

Fracture line distribution in femoral head fractures: a complement to Pipkin, Brumback, and AO/OTA classifications

Cited by 1 publication

References 18 publications

Clinical Evaluation of Femoral Head Fractures: Which Classification Systems Have the Best Universality, Reliability, and Reproducibility?

Clinical Evaluation of Femoral Head Fractures: Which Classification Systems Have the Best Universality, Reliability, and Reproducibility?

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