Intra- and inter-rater reliability of a three-dimensional classification system for intertrochanteric fracture using computed tomography

Wada, Keizo; Mikami, Hiroshi; Toki, Shunichi; Amari, Rui; Takai, Makoto; Sairyo, Koichi

doi:10.1016/j.injury.2020.07.047

Cited by 12 publications

(13 citation statements)

References 18 publications

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“…Currently, treatment failure rates for intertrochanteric hip fractures range from 9% to 16%, with successful surgical integration often being achieved at the expense of a significantly shorter femoral neck (12). In the past, implants that restore and maintain the anatomy of the hip have resulted in high failure rates.…”

Section: Discussionmentioning

confidence: 99%

Clinical study on the effect of intramedullary fixation and extramedullary fixation on unstable intertrochanteric fractures

Zhang¹,

Zhang²,

Yang³

2021

Ann Palliat Med

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Background: Intertrochanteric fracture of femur is a common fracture in the elderly, and the number of intramedullary nails used to manage intertrochanteric fractures has steadily increased, but the evidence for the clinical efficacy of this practice is lacking. The present study retrospectively compared the clinical outcomes and imaging features of patients with unstable intertrochanteric hip fractures treated with traditional extramedullary hip screws (AO/OTA 31-A2) and patients with the same injury treated with newer intramedullary screws.Methods: Lower limb measurement (LLM) for the main results of the hip-specific tools, functional independence measure (FIM), and "timed up and go" (TUG) to test the scale and timing of the 2-minute walk test were used as secondary tools for clinical outcomes. Other detailed radiological parameters to evaluate the fracture movement, such as heterotopic ossification, and implant failure, were also recorded.Results: There were no significant differences between the intramedullary and extramedullary treatment groups in terms of the measures acquired by the primary or secondary clinical outcome tools (P>0.05), but the radiographic parameters favored the intramedullary treatment group as it showed reduced femoral neck shortening.Conclusions: Although treatment with intramedullary nailing resulted in better radiographic assessment results, this did not translate into better functional recovery outcomes.

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Section: Discussionmentioning

confidence: 99%

Clinical study on the effect of intramedullary fixation and extramedullary fixation on unstable intertrochanteric fractures

Zhang¹,

Zhang²,

Yang³

2021

Ann Palliat Med

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“…Many articles argue that it is important to have excellent reliability in the classification of proximal femur fractures; however, we do not believe that this should be the sole decisive factor. Such a conclusion using the traditional AO/OTA classification system was reached by Cho et al [ 2 ] involving 59 patients and four observers, and Wada et al [ 24 ] analyzing 203 trochanteric fractures. Although we acknowledge the importance of inter- and intra-observer agreement, we believe that further analysis of consistency using more reliable graphical images such as CT is more crucial.…”

Section: Discussionmentioning

confidence: 94%

Posterior Protrusion Measures (PPM) as an Innovative Index in Classifying Plain Lateral Radiograph Images of Pertrochanteric Fracture Using the Revised AO Foundation/Orthopaedic Trauma Association (AO/OTA) Classification

Noda¹,

Takahara²,

Inui³

et al. 2022

Cureus

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“…The disagreement between measuring inaccuracy and uncertainty and the precise threshold figure (20.5 mm), makes it difficult for clinical application of the lateral wall thickness. Using CT scanning and 3D-CT reconstruction can greatly improve the measurement accuracy and enhance the agreement of classification (7)(8)(9)(10)(11).…”

Section: Measurement Of Lateral Wall Thicknessmentioning

confidence: 99%

“…Since the release of the AO/OTA-2018 edition, there were several studies on this new classification system, for example, what should be filled in the blank of A2.1 subtype (5), the accuracy and inter-and intra-observer reliability (6), and the diagnostic value of adding 3D-CT evaluation (7)(8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

A sophisticated fracture classification system of the proximal femur trochanteric region (AO/OTA-31A) based on 3D-CT images

et al. 2022

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ObjectiveFracture classification evolves dynamically with new and enhanced imaging modalities. This paper aims to introduce a novel hypothesis of a sophisticated fracture classification system for the proximal femur trochanteric region (AO/OTA-31A) based on 3D-CT images and accommodate the clinical requirement of the worldwide outbreak of geriatric hip fractures with large amounts of surgical operations.MethodsIn the current practice of widely preoperative 3D-CT application and cephalomedullary nailing, we attempt to propose a new comprehensive classification system to describe the fracture characteristics in a more detailed and sophisticated architecture, and pay the most important concern to the parameters that contribute to fracture stability reconstruction in osteosynthesis.ResultsThe new four-by-four comprehensive classification system, followed the structure of the AO/OTA system, incorporates many fracture characteristics as dividing indexes into multiple grade levels, such as fracture line direction, the number of fragments, the lesser trochanter fragment and its distal extension (>2 cm), the posterior coronal fragment and its anterior expansion (to the entry portal of head–neck implant at the lateral cortex), the lateral wall and anterior cortex fracture, and the anteromedial inferior corner comminution. From a panoramic perspective, there are four types and each type has four subtypes. A1 is simple two-part fractures (20%), A2 is characterized by lesser trochanter fragment and posterior coronal fractures (62.5%), A3 is reverse obliquity and transverse fractures with complete lateral wall broken (15.5%), and A4 is medial wall comminution which further lacks anteromedial cortex transmission of compression force (2%). For subtypes, A2.2 is with a banana-like posterior coronal fragment, A2.4 is with distal cortex extension >2 cm of the lesser trochanter and anterior expansion of the posterior coronal fragment(s) to the entry portal of head–neck implants, A3.4 is a primary pantrochanteric fracture, and A4.4 is a concomitant ipsilateral segmental fracture of the neck and trochanter region.ConclusionClassification represents diversity under consistency. The four-by-four sophisticated classification system delineates fracture characteristics in more detail. It is applicable in the time of rapid outbreak of trochanteric fractures in the older population, the large amounts of surgical operations, and incorporates various rare and/or more complicated subtypes which is unclassifiable before.

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Intra- and inter-rater reliability of a three-dimensional classification system for intertrochanteric fracture using computed tomography

Cited by 12 publications

References 18 publications

Clinical study on the effect of intramedullary fixation and extramedullary fixation on unstable intertrochanteric fractures

Clinical study on the effect of intramedullary fixation and extramedullary fixation on unstable intertrochanteric fractures

Posterior Protrusion Measures (PPM) as an Innovative Index in Classifying Plain Lateral Radiograph Images of Pertrochanteric Fracture Using the Revised AO Foundation/Orthopaedic Trauma Association (AO/OTA) Classification

A sophisticated fracture classification system of the proximal femur trochanteric region (AO/OTA-31A) based on 3D-CT images

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