DO TRACTION-INTERNAL ROTATION X-RAYS HAVE AN AFFECT ON THE TREATMENT OPTIONS OF PROXIMAL FEMUR FRACTURES AMONG ORTHOPEDIC SURGEONS WITH DIFFERENT LEVELS OF EXPERTISE?
Abstract
Objective: The purpose of the current study was to investigate whether the traction-internal rotation X-ray used in proximal femur fractures actually alters the implant choice among 12 different levels of expertise orthopaedic surgeons.
Material and Methods: The radiographs of 50 patients who were treated due to proximal femur fracture in our clinic were identified retrospectively. Twelve orthopaedic surgeons evaluated the patient X-rays in two different rounds, two weeks apart. Each observer was asked to independently examine the anteroposterior radiographs of both hips in the first round and the traction-internal rotation radiographs in the second round. Inter-observer agreement was determined using the Fleiss’ Kappa statistic, while intra-observer agreement was calculated using the Kappa statistic.
Results: A total of 50 patients with proximal femur fractures were included in our study. 26 of the patients were female (52%) and 24 (48%) were male. The average age of the participants was 70 (50±94). The implant options were as follows: total hip arthroplasty, hemiarthroplasty, proximal femur nail, long femur nail, 95° AO blade plate, anatomical plate, cannulated screw and dynamic hip screw. The intraobserver agreement was found to be moderate to substantial (κ=0.44-0.68) in consultant trauma surgeons, moderate in senior orthopaedic surgeons (κ=0.47-0.56) and fair to moderate (κ=0.24-0.59) in orthopaedic residents. The inter-observer agreement was moderate to substantial between consultant trauma surgeons (κ=0.56-0.62), moderate agreement between senior orthopaedic surgeons and fair agreement between orthopaedic residents respectively (κ=0.45, κ=0.30).
Conclusion: Traction radiography is crucial in the proper classification of proximal femur fractures in accordance with the literature. This study shows that as professional experience increases, traction radiography increases the consistency in surgical implant selection.
References
- Emmerson BR, Varacallo MA, Inman D. Hip Fracture Overview. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023. google scholar
- Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 2006;17(12):1726-33. [CrossRef] google scholar
- Deandrea S, Lucenteforte E, Bravi F, Foschi R, La Vecchia C, Negri E. Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis. Epidemiology 2010;21(5):658-68. [CrossRef] google scholar
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- Andersen E, Jorgensen LG, Hededam LT. Evans’ classification of trochanteric fractures: an assessment of the interobserver and intraobserver reliability. Injury 1990;21(6):377-8. [CrossRef] google scholar
- Deleanu B, Prejbeanu R, Tsiridis E, Vermesan D, Crisan D, Haragus H, et al. Occult fractures of the proximal femur: imaging diagnosis and management of 82 cases in a regional trauma center. World J Emerg Surg 2015;10:55. [CrossRef] google scholar
- Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and dislocation classification compendium-2018. J Orthop Trauma 2018;32(Suppl 1):S1-170. [CrossRef] google scholar
- Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33(1):159-74. [CrossRef] google scholar
- Ly T, Swiontkowski M. Intracapsular hip fractures. Skeletal trauma: basic science, management, and reconstruction Fifth Edit Philadelphia, PA: Saunders. 2014:1607-81. google scholar
- Wiltse LL. Internal rotation for the diagnosis of impacted fracture of the hip. Clin Orthop Relat Res 1974;(103):20. [CrossRef] google scholar
- Mitchell PM, Gavrilova SA, Dodd AC, Attum B, Obremskey WT, Sethi MK. The impact of resident involvement on outcomes in orthopedic trauma: An analysis of 20,090 cases. J Clin Orthop Trauma 2016;7(4):229-33. [CrossRef] google scholar
- Koval KJ, Oh CK, Egol KA. Does a traction-internal rotation radiograph help to better evaluate fractures of the proximal femur? Bull NYU Hosp Jt Dis 2008;66(2):102-6. google scholar
- Khurana B, Mandell JC, Rocha TC, Duran-Mendicuti MA, Jimale H, Rosner B, et al. Internal rotation traction radiograph improves proximal femoral fracture classification accuracy and agreement. AJR Am J Roentgenol 2018;211(2):409-15. [CrossRef] google scholar
- Garcia-Serrano MC, Garcia-Guerrero LF, Gomez-Gelvez A, Pinzon-Rendon AA. Diagnostic imaging concordance study: Are traction radiographs necessary in a hip fracture? Injury 2021;52(6):1445-9. [CrossRef] google scholar
- Chan G, Hughes K, Barakat A, Edres K, da Assuncao R, Page P, et al. Inter- and intra-observer reliability of the new AO/OTA classification of proximal femur fractures. Injury 2021;52(6):1434-7. [CrossRef] google scholar
- Perez-Abdala JI, Huespe I, Vildoza S, Novillo M, Llano L, Carabelli G, et al. The internal rotation traction radiograph does not improve the reliability in the AO classification system for pertrochanteric fractures. An inter- and intra-observer reliability assessment. Injury 2023;54(Suppl 6):110779. [CrossRef] google scholar
- Socci AR, Casemyr NE, Leslie MP, Baumgaertner MR. Implant options for the treatment of intertrochanteric fractures of the hip: rationale, evidence, and recommendations. Bone Joint J. 2017;99-B(1):128-33. [CrossRef] google scholar
- Alessio-Mazzola M, Traverso G, Coccarello F, Sanguineti F, Formica M. Dynamic hip screw versus intramedullary nailing for the treatment of A1 intertrochanteric fractures: A retrospective, comparative study and cost analysis. Jt Dis Relat Surg 2022;33(2):314-22. [CrossRef] google scholar
PROKSİMAL FEMUR KIRIKLARINDA ÇEKİLEN TRAKSİYON-İÇ ROTASYON GRAFİSİ FARKLI TECRÜBEDEKİ ORTOPEDİ HEKİMLERİNİN TEDAVİ SEÇENEKLERİNİ ETKİLİYOR MU?
Abstract
Amaç: Bu çalışmanın amacı, proksimal femur kırıklarında kullanılan traksiyon-iç rotasyon röntgeninin, 12 farklı uzmanlık seviyesindeki ortopedik cerrahlar arasında implant seçimini gerçekten değiştirip değiştirmediğini araştırmaktır.
Gereç ve Yöntem: Kliniğimizde proksimal femur kırığı nedeniyle tedavi edilen 50 hastanın radyografileri retrospektif olarak belirlendi. Hasta röntgenleri 12 ortopedik cerrah tarafından iki hafta arayla iki farklı turda değerlendirildi. İlk turda her gözlemciden her iki kalçanın ön-arka radyografilerini, ikinci turda ise traksiyon-iç rotasyon radyografilerini bağımsız olarak incelemeleri istendi. Gözlemciler arası uyum için Fleiss Kappa istatistiği, gözlemciler içi uyum için Cohen Kappa kat sayısı kullanıldı.
Bulgular: Çalışmamıza proksimal femur kırığı olan toplam 50 hasta dahil edildi. Hastaların 26'sı (%52) kadın, 24'ü (%48) erkekti. Katılımcıların yaş ortalaması 70 (50±94) idi. İmplant seçenekleri total kalça artroplastisi, hemiartroplasti, proksimal femur çivisi, uzun femur çivisi, 95° AO blade plak, anatomik plak, kanüllü vida ve dinamik kalça vidası olarak belirlendi. Gözlemciler içi uyum danışman travma cerrahlarında orta ila önemli (κ=0,44-0,68), kıdemli ortopedi cerrahlarında orta (κ=0,47-0,56) ve ortopedi asistanlarında ortanın altı ve orta (κ=0,24-0,59) olarak saptandı. Gözlemciler arasında uyum ise danışman travma cerrahları arasında orta ila önemli düzeyde (κ=0,56-0,62), kıdemli ortopedi cerrahlar arasında orta derecede ve ortopedi asistanları arasında ortanın altı düzeyde (κ=0,45, κ=0,30) idi.
Sonuç: Traksiyon radyografisi proksimal femur kırıklarının literatüre uygun olarak doğru sınıflandırılmasında önemlidir. Bu çalışma mesleki deneyim arttıkça traksiyon radyografisinin cerrahi implant seçiminde tutarlılığı arttırdığını göstermektedir.
References
- Emmerson BR, Varacallo MA, Inman D. Hip Fracture Overview. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023. google scholar
- Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 2006;17(12):1726-33. [CrossRef] google scholar
- Deandrea S, Lucenteforte E, Bravi F, Foschi R, La Vecchia C, Negri E. Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis. Epidemiology 2010;21(5):658-68. [CrossRef] google scholar
- Blundell CM, Parker MJ, Pryor GA, Hopkinson-Woolley J, Bhonsle SS. Assessment of the AO classification of intracapsular fractures of the proximal femur. J Bone Joint Surg Br 1998;80(4):679-83. [CrossRef] google scholar
- Andersen E, Jorgensen LG, Hededam LT. Evans’ classification of trochanteric fractures: an assessment of the interobserver and intraobserver reliability. Injury 1990;21(6):377-8. [CrossRef] google scholar
- Deleanu B, Prejbeanu R, Tsiridis E, Vermesan D, Crisan D, Haragus H, et al. Occult fractures of the proximal femur: imaging diagnosis and management of 82 cases in a regional trauma center. World J Emerg Surg 2015;10:55. [CrossRef] google scholar
- Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and dislocation classification compendium-2018. J Orthop Trauma 2018;32(Suppl 1):S1-170. [CrossRef] google scholar
- Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33(1):159-74. [CrossRef] google scholar
- Ly T, Swiontkowski M. Intracapsular hip fractures. Skeletal trauma: basic science, management, and reconstruction Fifth Edit Philadelphia, PA: Saunders. 2014:1607-81. google scholar
- Wiltse LL. Internal rotation for the diagnosis of impacted fracture of the hip. Clin Orthop Relat Res 1974;(103):20. [CrossRef] google scholar
- Mitchell PM, Gavrilova SA, Dodd AC, Attum B, Obremskey WT, Sethi MK. The impact of resident involvement on outcomes in orthopedic trauma: An analysis of 20,090 cases. J Clin Orthop Trauma 2016;7(4):229-33. [CrossRef] google scholar
- Koval KJ, Oh CK, Egol KA. Does a traction-internal rotation radiograph help to better evaluate fractures of the proximal femur? Bull NYU Hosp Jt Dis 2008;66(2):102-6. google scholar
- Khurana B, Mandell JC, Rocha TC, Duran-Mendicuti MA, Jimale H, Rosner B, et al. Internal rotation traction radiograph improves proximal femoral fracture classification accuracy and agreement. AJR Am J Roentgenol 2018;211(2):409-15. [CrossRef] google scholar
- Garcia-Serrano MC, Garcia-Guerrero LF, Gomez-Gelvez A, Pinzon-Rendon AA. Diagnostic imaging concordance study: Are traction radiographs necessary in a hip fracture? Injury 2021;52(6):1445-9. [CrossRef] google scholar
- Chan G, Hughes K, Barakat A, Edres K, da Assuncao R, Page P, et al. Inter- and intra-observer reliability of the new AO/OTA classification of proximal femur fractures. Injury 2021;52(6):1434-7. [CrossRef] google scholar
- Perez-Abdala JI, Huespe I, Vildoza S, Novillo M, Llano L, Carabelli G, et al. The internal rotation traction radiograph does not improve the reliability in the AO classification system for pertrochanteric fractures. An inter- and intra-observer reliability assessment. Injury 2023;54(Suppl 6):110779. [CrossRef] google scholar
- Socci AR, Casemyr NE, Leslie MP, Baumgaertner MR. Implant options for the treatment of intertrochanteric fractures of the hip: rationale, evidence, and recommendations. Bone Joint J. 2017;99-B(1):128-33. [CrossRef] google scholar
- Alessio-Mazzola M, Traverso G, Coccarello F, Sanguineti F, Formica M. Dynamic hip screw versus intramedullary nailing for the treatment of A1 intertrochanteric fractures: A retrospective, comparative study and cost analysis. Jt Dis Relat Surg 2022;33(2):314-22. [CrossRef] google scholar
Details
| Primary Language | English |
|---|---|
| Subjects | Health Services and Systems (Other) |
| Journal Section | RESEARCH |
| Authors | |
| Publication Date | April 28, 2025 |
| Submission Date | November 12, 2024 |
| Acceptance Date | March 4, 2025 |
| Published in Issue | Year 2025 Volume: 88 Issue: 2 |
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