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The new AO classification system for intertrochanteric fractures allows better agreement than the original AO classification. An inter- and intra-observer agreement evaluation
•A new AO classification for trochanteric fractures was recently published; no studies have evaluated its inter- and intra-observer agreement.•We assessed 68 intertrochanteric fractures; fractures were classified using the original and the new AO classifications.•The inter-observer agreement using t...
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Published in: | Injury 2021-01, Vol.52 (1), p.102-105 |
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Main Authors: | , , , , , , |
Format: | Article |
Language: | English |
Subjects: | |
Citations: | Items that this one cites Items that cite this one |
Online Access: | Get full text |
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Summary: | •A new AO classification for trochanteric fractures was recently published; no studies have evaluated its inter- and intra-observer agreement.•We assessed 68 intertrochanteric fractures; fractures were classified using the original and the new AO classifications.•The inter-observer agreement using the new AO classification was significantly better than using its original version.•The new AO classification system allowed better agreement when distinguishing stable from unstable patterns.
A new AO classification for intertrochanteric fractures was recently published; no studies have evaluated its inter- and intra-observer agreement.
Six evaluators (three hip subspecialists and three residents) assessed radiographs of 68 intertrochanteric fractures; fractures were classified using the original and the new AO classifications. The cases were displayed in a random sequence after a six-week interval for repeat evaluation. We used the Kappa coefficient (k) to determine inter- and intra-observer agreement.
Inter-observer agreement was slight (k = 0.128 [0.092–0.170]) using the original and fair (k = 0.250 [0.186–0.327]), with the new AO classification. Orthopedic residents exhibited better agreement than hip surgeons using the original classification (k = 0.302 [0.210–0.416] and k= -0.018 [-0.058–0.029], respectively) and the new classification (k = 0.388 [0.294–0.514] and k = 0.109 [0.031–0.192], respectively). Using both classifications as dichotomous variables (stable or unstable patterns), the agreement was slight (k = 0.158 [0.074–0.246]) using the original classification and moderate (k = 0.425 [0.308–0.550]) with the new AO classification.
The agreement was fair using the original (k = 0.350 [0.278–0.424]) and the new (k = 0.295 [0.239 to 0.353]) AO classifications, respectively. Residents had better agreement than hip specialists using the original (k = 0.405 [0.303–0.512]) versus (k = 0.292 [0.193–0.293]) and the new classification (k = 0.449 [0.370 to 0.528] versus k = 0.129 [0.064 to 0.208]).
The inter-observer agreement using the new AO classification was significantly better than using its original version. Also, the new AO classification system allowed better agreement when distinguishing stable from unstable patterns. |
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ISSN: | 0020-1383 1879-0267 |
DOI: | 10.1016/j.injury.2020.07.020 |