Is surgeons' experience important on intra- and inter-observer reliability of classifications used for adult femoral neck fracture?

Turgut, Ali; Kumbaracı, Mert; Kalenderer, Önder; İlyas, Gökhan; Bacaksız, Tayfun; Karapınar, Levent

doi:10.1016/j.aott.2015.11.004

Cited by 21 publications

(20 citation statements)

References 18 publications

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“…The overall kappa value was 0.31 (0.38 for the surgeons and 0.27 for the residents). Turgut et al [45] reported on the inter-and intraobserver reliability of the Garden, Pauwels, and AO classification systems and whether surgeon experience influenced results. In their study, 15 observers were asked to review preoperative AP radiographs of 107 patients with femoral neck fractures on two separate occasions.…”

Section: Validitymentioning

confidence: 99%

Classifications in Brief: Garden Classification of Femoral Neck Fractures

Kazley

Banerjee

Abousayed

et al. 2018

Clin Orthop Relat Res

107

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Section: Validitymentioning

confidence: 99%

Classifications in Brief: Garden Classification of Femoral Neck Fractures

Kazley

Banerjee

Abousayed

et al. 2018

Clin Orthop Relat Res

107

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“…Our data supports this, as we could show the best inter-rater reliability in the two-staged classification in femoral neck fractures. Although all three observers are experienced consultants for traumatology and have a high intra-rater reliability, they were not able to perform more than a moderate inter-rater reliability in the Garden and AO classification, but this is according to the literature ( 11 ).…”

Section: Discussionmentioning

confidence: 98%

“…Each fracture is seen in our emergency department by an experienced trauma surgeon before admission to the ward, which limits the generalization to other hospitals or healthcare systems if only emergency registrars see the patient before operation. However, as mentioned above, experience seems to be of little influence for classification of these fracture types ( 11 ). Furthermore, as this is a retrospective study, the results should be verified by a prospective study.…”

Section: Discussionmentioning

confidence: 99%

No Consequence for Lateral View X-Ray in Displaced Proximal Femoral Fractures in the Elderly

et al. 2021

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Background: Due to demographic changes, proximal femoral fractures (PFF) in the elderly rise constantly. The standard diagnostic tool is still the X-ray of the pelvis/hip in two planes. Our hypothesis was that the lateral-view X-ray has little influence on classification, planning of the operative procedure, and choice of implant in geriatric patients.Methods: Retrospective analysis of all initial X-rays of PFF in geriatric patients (≥70 years) from May 2018 until August 2019 in a Level I Trauma center. Three experienced consultants categorized the fractures on the ap pelvis view and performed Garden and Pauwels classification as well as a two-staged classification displaced/nondisplaced [for femoral neck fractures (FNF)] or AO Classification [for intertrochanteric fractures (ITF)]. Afterward, they decided the operative strategy as well as implant choice [dynamic hip screw (DHS), intramedullary nail (IMN), or arthroplasty]. After 4 weeks, they categorized all fractures again with now available lateral view X-rays in a different order.Results: Two hundred seven patients (146 female, 61 male; 70.5 vs. 29.5%) with 90 FNF and 117 ITF (43.5 vs. 56.5%) could be included. Age was 84.6 ± 6.9 years. The treatment was in 45 cases DHS, in 82 cases IMN, and for the other 80 cases arthroplasty. The interobserver reliability of the classifications were poor, except for the two-staged classification [Fleiss-κ ap view only = 0.708 (CI 95% 0.604, 0.812) vs. additional lateral = 0.756 (CI 95% 0.644, 0.869)]. Moreover, independent from the classification, there were no significant changes in management and choice of implant with additional lateral view.Conclusions: Regarding our results, we consider the lateral view dispensable for standard X-ray of displaced PFF in geriatric patients. In nondisplaced fractures, it could be added secondary.

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“…In the past the Pauwels classification has also been studied, resulting in a poorly reliability classification and therefore no longer used in daily clinical practice [ 20 ] [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Femoral neck fracture: the reliability of radiologic classifications

Cazzato

Oliva

Masci

et al. 2022

BMC Musculoskelet Disord

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Background Femoral neck fractures (FNF) are one of the most common injury in the elderly. A valid radiographic classification system is mandatory to perform the correct treatment and to allow surgeons to facilitate communication. This study aims to evaluate reliability of 2018 AO/OTA Classification, AO/OTA simplified and Garden classification. Methods Six Orthopaedic surgeons, divided in three groups based on trauma experience, evaluated 150 blinded antero-posterior and latero-lateral radiography of FNF using Garden classification, 2018 AO/OTA and simplified AO/OTA classification. One month later, the radiographs were renumbered and then each observer performed a second evaluation of the radiographs. The Kappa statistical analysis was used to determine the reliability of the classifications. Cohen’s Kappa was calculated to determine intra and inter observer reliability. Fleiss’ Kappa was used to determine multi-rater agreement. Results The k values of interobserver reliability for Garden classification was from 0,28 to 0,73 with an average of 0,49. AO classification showed reliability from 0,2 to 0,42, with average of 0,30. Simplified AO/OTA classification showed a reliability from 0,38 to 0,58 with an average of 0,48. The values of intra observer reliability for Garden classification was from 0,48 to 0,79 with an average of 0,63. AO classification showed reliability from 0,2 to 0,64 with an average of 0,5. Simplified AO/OTA classification showed a reliability from 0,4 to 0,75 with an average of 0,61. Conclusion The revised 2018 AO/OTA classification simplified the previous classification of intracapsular fracture but remain unreliable with only fair interobserver reliability. The simplified AO/OTA classification show a reliability similar to Garden classification, with a moderate interobserver reliability. The experience of the surgeons seems not to improve reliability. No classification has been shown to be superior in terms of reliability.

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Is surgeons' experience important on intra- and inter-observer reliability of classifications used for adult femoral neck fracture?

Cited by 21 publications

References 18 publications

Classifications in Brief: Garden Classification of Femoral Neck Fractures

Classifications in Brief: Garden Classification of Femoral Neck Fractures

No Consequence for Lateral View X-Ray in Displaced Proximal Femoral Fractures in the Elderly

Femoral neck fracture: the reliability of radiologic classifications

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