Abstract
Purpose
The objective of our study was to evaluate the inter- and intra-observer reliability of the standard anteroposterior of both hips, traction-internal rotation, and the combination of the two radiographs for intertrochanteric fracture.
Methods
In one hundred cases, three sets of radiographs of intertrochanteric fracture were prepared. Two senior and two junior orthopedic trauma surgeons were asked to classify the radiograph according to AO/OTA classification. The standard both hips radiograph, traction-internal rotation radiograph and combination of both techniques were evaluated. All radiographs were evaluated at two different points in time for all observers. The inter- and intra-observer reliability were analyzed with the Kappa agreement index.
Results
Inter-observer agreement for standard radiographs was “substantial” in one while “moderate” in five among observers. After adding the traction radiograph to the standard radiograph, the agreement was improved to “substantial” in 4 while the rest was “moderate.”
Intra-observer agreement for standard radiographs was “substantial” in two observers and “moderate” in two observers. Adding traction to standard radiographs resulted in “substantial” in three observers and “moderate” in one observer.
Overall pattern stability was changed in 19% after adding the traction film. Thirty-four percent of the fracture which initially diagnosed as A2.1 was changed from stable to unstable fracture patterns after adding the traction film.
Conclusions
Adding traction-internal rotation radiograph to the standard radiograph is a useful method for improving agreement to classify intertrochanteric fracture regarding AO/OTA classification. This may be helpful in determining fracture classification.
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All data generated or analyzed during this study are included in this published article.
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CJ and PS were involved in drafting and revising the manuscript for content, including the medical writing for the content, the study concept and design, the analysis and interpretation of the data, as well as the acquisition of the data. PR and PK were involved in revising the manuscript for content as well as the analysis and interpretation of the data.
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Jiamton, C., Sayan, P., Rungchamrussopa, P. et al. Traction-Internal Rotation Radiograph Can Improve Agreement in AO/OTA Classification System for Intertrochanteric Fracture. JOIO 56, 1998–2005 (2022). https://doi.org/10.1007/s43465-022-00722-4
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DOI: https://doi.org/10.1007/s43465-022-00722-4