Intra- and inter-rater reliability of a three-dimensional classification system for intertrochanteric fracture using computed tomography. Issue 11 (November 2020)

• Record Type: Journal Article
• Authors: Wada, Keizo; Mikami, Hiroshi; Toki, Shunichi; Amari, Rui; Takai, Michihiro; Sairyo, Koichi
• Is Part Of: Injury. Volume 51:Issue 11(2020)
• Page Start: 2682
• Page End: 2685
• Publication Date: 2020-11
• Subjects: Intertrochanteric fracture -- Computed tomography -- Unstable fracture -- Classification system -- Fragility fracture -- Elderly patient -- Reliability; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2020.07.047
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: Using a fragment-based classification system, intertrochanteric fractures can be assessed in detail. Intra- and inter-rater reliability of the fragment-based classification is better than that of two-dimensional classification systems. The fragment-based classification system using CT is a reliable method for assessment of intertrochanteric fractures. Abstract: Introduction: Intertrochanteric fractures are common fragility fractures in elderly patients. The importance of a reliable classification system for these fractures has been increasingly recognized. The aim of this study was to test the hypothesis that three-dimensional classification by CT has better intra- and inter-observer reliability than conventional two-dimensional classification. Material and methods: Two hundred and three consecutive patients (39 male, 164 female; mean age 84.5 years) with intertrochanteric fracture were included in the study. In each case, the fracture was classified using the two-dimensional Evans-Jensen and AO/OTA systems that rely on plain radiographs and using a three-dimensional fragment-based CT system. The second evaluation was performed 1 month after the first evaluation by the same examiner to determine intra-observer reliability. Another blinded examiner also classified each case to assess inter-observer reliability. The kappa coefficient was used for determination of intra- and inter-observer reliability. Results: The kappa values for the two-dimensional Evans-Jensen and AO/OTA classification systems showed moderate intra-observer reliability (κ=0.65 and κ=0.61, respectively) and slight inter-observer reliability (κ=0.20 and κ=0.19). The intra-observer kappa value for the three-dimensional classification system was 0.88, indicating almost perfect reliability; the inter-observer kappa value was 0.70, indicating substantial reliability. Conclusion: The findings of this study confirm that the fragment-based classification system has high reliability. Surgeons should be aware that the three-dimensional fragment-based CT system for classification of intertrochanteric fractures has better intra-observer and inter-observer reliability than the conventional two-dimensional systems.