CT scan does not improve the reproducibility of trochanteric fracture classification: a prospective observational study of 53 cases.

INTRODUCTION: The reproducibility of various classification systems for trochanteric fractures is poor. This problem could be related to a lack of readability when using conventional X-rays. HYPOTHESIS: Computed tomography scanning (CT scan) will improve the interobserver reproducibility of the AO classification for trochanteric fractures. PATIENTS AND METHODS: This was a prospective, observational, descriptive study following a group of 53 patients with trochanteric fractures. The fractures were evaluated with conventional X-rays, CT scan slices and 3D reconstruction (3DR). The resulting images were blinded and analysed by two observers using two classification systems: AO and Evans modified by Jensen (EVJE). A sample size of 53 was needed to show an improvement in the interobserver reproducibility when deciding the AO classification type with CT scan images. Kappa coefficients were used to measure interobserver reproducibility and agreement; agreement is the degree of consistency in the analysis by one observer who views the same fracture on two different imaging modalities. RESULTS: The interobserver reproducibility for the AO classification was 0.28 for X-rays, 0.33 for CT scan and 0.28 for 3DR. For the EVJE classification, these coefficients were 0.50 for X-rays, 0.35 for CT scan and 0.47 for 3DR. The agreement rate between the two imaging modalities was between 0.38 and 0.58 for X-rays/CT scan and between 0.79 and 0.86 for CT scan/3DR. DISCUSSION: The primary objective of this study was not achieved. CT imaging does not improve the interobserver reproducibility of various classification systems for trochanteric fractures. However, by providing images as slices, the complex nature of fractures in this area was revealed. The challenges related to classifying various fractures are not exclusively related to a "readability" problem, but also an understanding and analysis problem. LEVEL OF EVIDENCE: Prospective diagnostic study, level III.

Infections of the spinal column--spondylodiscitis.

Infectious spondylodiscitis is an infection of the intervertebral disc and the adjacent vertebral bodies due to the introduction of a pyogen, usually by the haematogenous route. Plain film radiography (which is usually normal in the early stages) shows blurring of the vertebral endplates and a loss of disc height that progresses quickly. MRI is the examination of choice, as it detects oedema within the trabecular bone very early, before the onset of destruction. Injection of a contrast medium with fat signal saturation improves detection and visualisation of the spread of infection in the soft tissue and epidural space. Imaging can also be used to guide a needle aspiration to investigate the infective agent.

[Imaging features of pubalgia]. / Imagerie des pubalgies.

Pubalgia is a generic term used to describe groin pain due to a multitude of different etiologies such as skeletal (microtraumatic pubic symphysis arthropathy), muscular (adductor or rectus abdominis disorders), or abdominal wall (inguinal hernia) disorders. Diagnosis relies mainly on MRI for musculoskeletal disorders and ultrasound for abdominal wall disorders.

[Evolution of the pelvis and hip throughout history: from primates to modern man]. / Évolution du bassin et de la hanche « à travers les âges ¼: des primates à l'homme moderne.

The evolution to a bipedal mode of locomotion was accompanied by a verticalization of the spine and a modification in the shape of the pelvis: horizontal curvature and sagittal rotation. Phylogenesis meets ontogenesis: flat bones in fetuses similar to the monkey, australopithecus features at birth and "human-like" features by 7 or 8years of age. These anatomical modifications explain the characteristics of human bipedalism: stable, economical, with hip and knee extension in the standing position with little lateral motion. Some pathologies induce a regression to a more archaic mode of bipedal locomotion.