The intra- and interobserver reliability of five commonly used intertrochanteric femur fracture classification systems

Abstract

Almost a half of the hip fractures are extracapsular and are subclassified as intertrochanteric and subtrochanteric. [1] Fracture stability or fracture classification systems are used for the recommendation of treatment in intertrochanteric fractures. Such classifications are also used to recommend proper implant or surgical techniques. The ideal classification system allows interaction between physicians, guides the planning, predicts the treatment outcome, and is applicable for clinical practice and research. Examination of the fracture evaluation by the same physician and different physicians should yield the same result each time (intraobserver and interobserver reliability).Objectives: This study aims to evaluate the effect of surgical experience on reliability for Boyd-Griffin, Evans/Jensen, Evans, Orthopaedic Trauma Association (main and subgroups), and Tronzo classification systems.Patients and methods: Between January 2013 and December 2014, radiological images of a total of 60 patients (13 males, 47 females; mean age: 78.9±21.9 years; range, 61 to 96 years) with the diagnosis of intertrochanteric femur fracture were analyzed. Radiographs were evaluated and classified by five residents and five orthopedics and traumatology surgeons according to the Evans, Boyd-Griffin, Evans/Jensen, OTA, and Tronzo classification systems. Intraand interobserver reliability were calculated using the kappa statistics. Results:The worst intraobserver compatibility among the residents was the classification system with OTA subgroups (k=0.516), while the classification system with the best intraobserver fit was found to be OTA main groups (k=0.744). The worst agreement among surgeons was in the Evans classification system (k=0.456). However, the best intraobserver agreement was in the OTA main groups (k=0.741). The best interobserver agreement was observed regarding the OTA main groups (k=0.699). Conclusion:The classification that has the best harmony both among residents and surgeons, and between residents and surgeons is the OTA main group classification.

Bilgisayarlı Tomografi İntertrokanterik Kırık Tedavisinde X-ray’e göre avantaj sağlar mı?

“…Better results are obtained when only the main fracture groups (A1, A2, A3) are considered. [15][16][17] In our study, we used AO/OTA main groups, which can be the primary guide for selecting implants to be used in the treatment and increase reproducibility.…”

A novel computed tomography-based three-column MLP classification of intertrochanteric fracture

“…According to literatures published recently, although scholars proposed several classi cation systems based on three-dimensional computed tomography, these studies emphasized particularly on morphological patterns of intertrochanteric fracture fragments, with relative lack of attention to proximal femur biomechanical characteristics and traumatic mechanism [4][5][6]. Moreover, it is vulnerable to obtain good consistency and reliability using these classi cation methods [3,7].…”

A novel computed tomography-based three-column MLP classification of intertrochanteric fracture

“…According to literature published recently, although scholars have proposed several classification systems based on three-dimensional computed tomography, these systems are mainly built based on morphological patterns of fracture fragments, without the involvement of proximal femoral biomechanical characteristics and traumatic mechanism (4)(5)(6). Moreover, the consistency and reliability are relatively vulnerable to using these classification methods (3,7).…”