Femoral neck fracture: the reliability of radiologic classifications.

BACKGROUND: Femoral neck fractures (FNF) are one of the most common injury in the elderly. A valid radiographic classification system is mandatory to perform the correct treatment and to allow surgeons to facilitate communication. This study aims to evaluate reliability of 2018 AO/OTA Classification, AO/OTA simplified and Garden classification. METHODS: Six Orthopaedic surgeons, divided in three groups based on trauma experience, evaluated 150 blinded antero-posterior and latero-lateral radiography of FNF using Garden classification, 2018 AO/OTA and simplified AO/OTA classification. One month later, the radiographs were renumbered and then each observer performed a second evaluation of the radiographs. The Kappa statistical analysis was used to determine the reliability of the classifications. Cohen's Kappa was calculated to determine intra and inter observer reliability. Fleiss' Kappa was used to determine multi-rater agreement. RESULTS: The k values of interobserver reliability for Garden classification was from 0,28 to 0,73 with an average of 0,49. AO classification showed reliability from 0,2 to 0,42, with average of 0,30. Simplified AO/OTA classification showed a reliability from 0,38 to 0,58 with an average of 0,48. The values of intra observer reliability for Garden classification was from 0,48 to 0,79 with an average of 0,63. AO classification showed reliability from 0,2 to 0,64 with an average of 0,5. Simplified AO/OTA classification showed a reliability from 0,4 to 0,75 with an average of 0,61. CONCLUSION: The revised 2018 AO/OTA classification simplified the previous classification of intracapsular fracture but remain unreliable with only fair interobserver reliability. The simplified AO/OTA classification show a reliability similar to Garden classification, with a moderate interobserver reliability. The experience of the surgeons seems not to improve reliability. No classification has been shown to be superior in terms of reliability.

Fractura de Hoffa / Hoffa's fracture

RESUMEN Introducción: Las fracturas del extremo distal del fémur son lesiones invalidantes. Entre ellas la fractura de Hoffa es una afección infrecuente de difícil diagnóstico y tratamiento. Objetivo: Actualizar sobre los elementos más importantes de esta enfermedad traumática. Métodos: La búsqueda y análisis de la información se realizó en un periodo de 60 días (primero de noviembre al 30 de diciembre de 2020) y se emplearon las siguientes palabras claves: Hoffa's fracture AND distal femur fracture a partir de la información obtenida se realizó una revisión bibliográfica de un total de 529 artículos publicados en las bases de datos PubMed, Hinari, SciELO y Medline mediante el gestor de búsqueda y administrador de referencias EndNote, de ellos se utilizaron 37 citas seleccionadas para realizar la revisión, 35 de los últimos cinco años. Resultados: Se menciona el mecanismo de producción de alta y baja energía. Se hace referencia a las clasificaciones basadas en la radiografía simple y la tomografía axial computarizada. Se exponen las principales enfermedades asociadas a la fractura de Hoffa. Con relación al tratamiento se mencionan las modalidades conservadoras y quirúrgicas, en esta última, las vías de abordaje según la localización y tipo de fractura, con especial énfasis en la cirugía artroscópica. Conclusiones: La fractura de Hoffa es una lesión infrecuente provocada por un mecanismo de producción de alta energía y asociada en ocasiones a otras enfermedades traumáticas. El tratamiento de esta afección es por lo general de tipo quirúrgico y la modalidad a emplear está basada en la configuración geométrica de la fractura.

ABSTRACT Introduction: Fractures of the distal end of the femur are disabling injuries, among them the Hoffa's fracture is an infrequent condition difficult to diagnose and treat. Objective: to update on the most important elements of this traumatic entity. Methods: The search and analysis of the information was carried out over a period of 60 days (November 1 to December 30, 2020) and the following words were used: Hoffa's fracture, AND distal femur fracture, based on the information obtained, a bibliographic review of a total of 529 articles published in the PubMed, Hinari, SciELO and Medline databases using the search manager and reference manager EndNote, 37 selected citations were used to perform the review, 35 of the last five years. Results: The mechanism of high and low energy production was mentioned. Reference was made to classifications based on plain radiography and computed tomography. The main entities associated with the Hoffa's fracture were exposed. In relation to treatment, conservative and surgical modalities were mentioned, in the latter, the approach routes according to the location and type of fracture, with special emphasis on arthroscopic surgery. Conclusions: Hoffa fracture is an infrequent injury caused by a high energy production mechanism and occasionally associated with other traumatic entities. The treatment of this condition is generally surgical; the modality to be used is based on the geometric configuration of the fracture.

Evaluation of the reproducibility of the Tronzo classification for intertrochanteric fractures of the femur / Avaliação da reprodutibilidade da classificação de Tronzo para fraturas intertrocantéricas do fêmur

Objective: To evaluate the inter-observer reproducibility of the Tronzo classification for transtrochanteric fractures using the kappa concordance coefficient (κ). Methods: Twenty radiographic images in anteroposterior view on hips with transtrochanteric fractures of the femur were used. These were classified by 12 observers using the Tronzo method. The images were presented in sequence and a questionnaire containing all the options of the Tronzo classification was filled out, along with a simplified classification using Tronzo divisions into two groups (stable and unstable). The data were analyzed by means of the kappa concordance test. Results: The following kappa indices were found: for images with stable fractures (Tronzo 1 and 2), 0.11; for images with unstable fractures (Tronzo 3, 3 variant, 4 and 5), 0.52; and for the complete classification, 0.44 (moderate concordance). In turn, the simplified classification did not increase the concordance rates. Conclusion: The Tronzo classification is unsuitable for clinical practice. We suggest that another system should be used or created for this type of fracture...

Objetivo: Avaliar a reprodutibilidade, interobservadores, da classificação de Tronzo para fraturas transtrocantéricas com o uso do coeficiente de concordância kappa (κ). Métodos: Foram usadas 20 imagens de radiografias do quadril na incidência anteroposterior com fraturas transtrocantéricas do fêmur, classificadas, segundo Tronzo, por 12 observado-res. As imagens foram apresentadas em sequência e foi preenchido um questionário com todas as opções da classificação de Tronzo, além da classificação simplificada, com a divi-são de Tronzo em dois grupos (estáveis e instáveis). Os dados foram analisados por meio do teste de concordância de kappa. Resultados: Foram encontrados os seguintes índices de kappa: para imagens com fraturas estáveis (Tronzo 1 e 2), 0,11; para imagens com fraturas instáveis (Tronzo 3, 3 variante, 4 e 5), 0,52; e para a classificação completa, 0,44 (concordância moderada). Por sua vez, a classificação simplificada não aumentou os índices de concordância. Conclusão: A classificação de Tronzo não é adequada para a prática clínica. Sugerimos o uso ou a criação de outro sistema para esse tipo de fratura...

Evaluation of the reproducibility of the Tronzo classification for intertrochanteric fractures of the femur.

OBJECTIVE: To evaluate the inter-observer reproducibility of the Tronzo classification for transtrochanteric fractures using the kappa concordance coefficient (κ). METHODS: Twenty radiographic images in anteroposterior view on hips with transtrochanteric fractures of the femur were used. These were classified by 12 observers using the Tronzo method. The images were presented in sequence and a questionnaire containing all the options of the Tronzo classification was filled out, along with a simplified classification using Tronzo divisions into two groups (stable and unstable). The data were analyzed by means of the kappa concordance test. RESULTS: The following kappa indices were found: for images with stable fractures (Tronzo 1 and 2), 0.11; for images with unstable fractures (Tronzo 3, 3 variant, 4 and 5), 0.52; and for the complete classification, 0.44 (moderate concordance). In turn, the simplified classification did not increase the concordance rates. CONCLUSION: The Tronzo classification is unsuitable for clinical practice. We suggest that another system should be used or created for this type of fracture.

OBJETIVO: Avaliar a reprodutibilidade, interobservadores, da classificação de Tronzo para fraturas transtrocantéricas com o uso do coeficiente de concordância kappa (κ). MÉTODOS: Foram usadas 20 imagens de radiografias do quadril na incidência anteroposterior com fraturas transtrocantéricas do fêmur, classificadas, segundo Tronzo, por 12 observadores. As imagens foram apresentadas em sequência e foi preenchido um questionário com todas as opções da classificação de Tronzo, além da classificação simplificada, com a divisão de Tronzo em dois grupos (estáveis e instáveis). Os dados foram analisados por meio do teste de concordância de kappa. RESULTADOS: Foram encontrados os seguintes índices de kappa: para imagens com fraturas estáveis (Tronzo 1 e 2), 0,11; para imagens com fraturas instáveis (Tronzo 3, 3 variante, 4 e 5), 0,52; e para a classificação completa, 0,44 (concordância moderada). Por sua vez, a classificação simplificada não aumentou os índices de concordância. CONCLUSÃO: A classificação de Tronzo não é adequada para a prática clínica. Sugerimos o uso ou a criação de outro sistema para esse tipo de fratura.