Low interobserver reliability of radiographic signs predicting healing disturbance in displaced intracapsular fracture of the femoral neck

Bjørgul, Kristian; Reikerås, Olav

doi:10.1080/000164702320155301

Cited by 27 publications

(8 citation statements)

References 6 publications

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“…This study provides evidence of the usefulness of classifying the fractures as being undisplaced or moderately displaced. Previous studies have shown that the Garden classification system is unreliable (Eliasson et al 1988, Frandsen et al 1988, Thomsen et al 1996, Bjorgul and Reikeras 2002, but the interobserver reliability may be acceptable when distinguishing between displaced and undisplaced fractures (Eliasson et al 1988, Frandsen et al 1988, Thomsen et al 1996, Bjorgul and Reikeras 2002. The significant difference in healing complications in our study indicates that moderately displaced fractures behave differently from undisplaced fractures.…”

Section: Discussioncontrasting

confidence: 37%

“…However, it may be difficult to determine the healing potential of the fracture. We have demonstrated that the interobserver reliability of the signs predicting healing disturbances is low (Bjorgul and Reikeras 2002). Since the fracture pattern most likely reflects a continuum of increasing displacement, a clear distinction between undisplaced fractures and moderately displaced fractures may not exist.…”

Section: Discussionmentioning

confidence: 99%

“…All physicians were familiar with the radiographic criteria of Alho et al (1992). We have previously conducted a study investigating the interobserver reliability of the criteria (Bjorgul and Reikeras 2002) and found that the kappa values for the specific criteria showed low to moderate values. A small head fragment was defined as a distance of less than 15 mm from the center of the femoral head to the fracture line.…”

Section: Methodsmentioning

confidence: 99%

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Outcome of undisplaced and moderately displaced femoral neck fractures

Bjørgul

Reikerås

2007

Acta Orthopaedica

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Background The optimal treatment for femoral neck fracture is a matter of controversy. We compared the outcome of displaced fractures with good healing potential (moderately displaced fractures) to the outcome of undisplaced fractures treated by internal fixation with 2 parallel screws.Methods In a consecutive series of hip fracture patients, the rates of reoperation and mortality for 225 undisplaced fractures were compared to those for 241 moderately displaced fractures. The patients were followed for 1-6 years.Results The total rate of reoperation was 19% (9% because of healing complications) for the undisplaced fractures and 33% (20% because of healing complications) for the moderately displaced fractures. Fracture displacement was the main predictor of reoperation. There was no difference in mortality between the groups, and patient-related background parameters (rather than fracture displacement) were the main predictors of mortality. Interpretation Undisplaced fractures should be treated by internal fixation. The best treatment for moderately displaced fractures remains to be determined.

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Section: Discussioncontrasting

confidence: 37%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Outcome of undisplaced and moderately displaced femoral neck fractures

Bjørgul

Reikerås

2007

Acta Orthopaedica

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“…We have previously investigated the reliability of the criteria in a clinical setting (Bjorgul and Reikeras 2002) and we found that the interobserver reliability was low. There are many uncertainties in the clinical decision-making process, and several factors other than radiographic criteria might influence the choice of treatment.…”

Section: Discussionmentioning

confidence: 99%

Hemiarthroplasty in worst cases is better than internal fixation in best cases of displaced femoral neck fractures: A prospective study of 683 patients treated with hemiarthroplasty or internal fixation

Bjørgul

Reikerås

2006

Acta Orthopaedica

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Background Studies have shown that the degree of initial displacement and also comminution of the femoral calcar, size of the head and varus angulation are prognostic of failure in displaced femoral neck fracture. We have applied these radiographic criteria in order to select patients who would benefit from internal fixation as opposed to primary hemiarthroplasty, and this prospective study was conducted in order to monitor the results of this strategy.Methods 683 displaced fractures of the femoral neck were treated with internal fixation or primary hemiarthroplasty based on the proposed radiographic criteria in a prospective consecutive study, and the patients were followed for 1-6 years. We treated 228 fractures with internal fixation and 455 by bipolar hemiprosthesis. The choice of operation was based on clinical evaluation of the patient and assessment of the assumed healing potential of the fracture, as determined by radiographic evaluation. Revision and mortality were primary endpoints.Results 54 (24%) of the patients originally treated by osteosynthesis were revised, whereas 9 (2%) of the patients treated with hemiarthroplasty had revision surgery. There were no significant differences in mortality between the groups at 30, 120 or 365 days.Interpretation Even when treating only the fractures with the assumed best healing potential with internal fixation, the results are inferior to hemiarthroplasty.

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“…[6][7][8][9][10] Given the paucity of literature, our objectives were 3-fold: (1) to evaluate agreement (interobserver and intraobserver agreement) in femoral neck fracture healing assessments among a group of skilled reviewers, (2) to examine the performance of a novel radiographic checklist for fracture healing, and (3) to compare performance between orthopedic surgeons and radiologist reviewers in the assessment of fracture healing. We hypothesized considerable variability in the assessment of fracture healing overall with little difference across subspecialty of reviewers.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Radiographic Fracture Healing in Patients With Operatively Treated Femoral Neck Fractures

Bhandari

Chiavaras

Ayeni

et al. 2013

Journal of Orthopaedic Trauma

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The level of agreement between and within orthopedic surgeon and radiologist reviewers in the assessment of fracture healing is low, though intrarater agreement is high. The RUSH score shows promise as a tool to improve agreement on fracture healing. Studies evaluating reliability and accuracy of healing with clinical information and temporal evaluation are needed and may further improve agreement.

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Low interobserver reliability of radiographic signs predicting healing disturbance in displaced intracapsular fracture of the femoral neck

Cited by 27 publications

References 6 publications

Outcome of undisplaced and moderately displaced femoral neck fractures

Outcome of undisplaced and moderately displaced femoral neck fractures

Hemiarthroplasty in worst cases is better than internal fixation in best cases of displaced femoral neck fractures: A prospective study of 683 patients treated with hemiarthroplasty or internal fixation

Assessment of Radiographic Fracture Healing in Patients With Operatively Treated Femoral Neck Fractures

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