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Inter- and intra-observer reliability of the new AO/OTA classification of proximal femur fractures.

Authors
  • Chan, G1
  • Hughes, K2
  • Barakat, A3
  • Edres, K2
  • da Assuncao, R2
  • Page, P2
  • Dawe, E2
  • 1 Department of Trauma & Orthopaedics, Western Sussex Hospitals NHS Foundation Trust, United Kingdom. Electronic address: [email protected] , (United Kingdom)
  • 2 Department of Trauma & Orthopaedics, Western Sussex Hospitals NHS Foundation Trust, United Kingdom. , (United Kingdom)
  • 3 Department of Trauma & Orthopaedics, Brighton & Sussex Hospitals NHS Trust, United Kingdom. , (United Kingdom)
Type
Published Article
Journal
Injury
Publication Date
Jun 01, 2021
Volume
52
Issue
6
Pages
1434–1437
Identifiers
DOI: 10.1016/j.injury.2020.10.067
PMID: 33097201
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Hip fractures are a global health burden, with an incidence that is projected to increase from 66,000/year currently in the United Kingdom to 100,000/year by 2033. The classification of intertrochanteric fractures is key to the treatment algorithms advising on their surgical management. The AO/OTA classification is the most commonly used system, initially published in 1990 and subsequently shown to have poor inter- and intra-observer reliability, it was revised in 2018 with the main aim of re-classifying and further defining the 31-A2 group. 150 plain film anteroposterior and lateral plain film radiographs of intertrochanteric fractures from three hospitals were classified using the 2018 AO/OTA classification of intertrochanteric fractures by six Orthopaedic Surgeons (2 Consultants, 4 Trainees), all were blinded to the definitive surgical treatment for patients. Radiographs were re-classified after a minimum of 3-months, Cohen's Kappa for inter-observer reliability was calculated from first round classifications and intra-observer reliability from first and second classifications. Mean Kappa for inter-observer reliability for AO group classification (e.g. 31-A1) was 0.479 (0.220 - 0.771, for sub-group classification (e.g. 31-A1.1) reliability reduced to 0.376 (0.276 - 0.613). Intra-observer reliability was comparable for both group and sub-group classifications, 0.661 and 0.587 respectively. The revised 2018 AO/OTA classification aimed to simply the classification of intertrochanteric fractures, however it remains unreliable with only a "moderate" inter-observer reliability at group level with this falling to "fair" when sub-group classifications are made. Identification of stable and unstable injuries using the new AO/OTA system remains fraught with difficulties and appears difficult to apply with consistent accuracy. Copyright © 2020 Elsevier Ltd. All rights reserved.

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