Abstract
Amaç: İntertrokanterik kırıklarda başarılı bir tedavi uygun bir implanta bağlıdır ve buna kırık sınıflaması ve stabilitesine göre karar verilir. Çalışmamızda intertrokanterik kırıklarda x-ray ve/veya bilgisayarlı tomografi (BT)’nin kırık sınıflamasında ve tedavi için implant seçiminde gözlemciler arası ve gözlemci içi tutarlılığını araştırmayı amaçladık.
Gereç ve Yöntemler: Travma tecrübesi beş yıl ve üzerinde olan iki ortopedist tarafından 80 intertrokanterik kırık tanısı almış aynı zamanda eşlik eden kırık şüphesine yönelik pelvis BT taraması yapılmış hastalar değerlendirmeye alındı. AO/OTA sınıflaması ve tedavi için implant seçimi x-ray ve/veya BT ye göre yapıldı. İki hafta sonra ikinci değerlendirler yapıldı. Birinci değerlendirme gözlemciler arası güvenilirlik, birinci ve ikinci değerlendirmelerde gözlemci içi güvenilirlik açısından Cohen's Kappa hesaplandı.
Bulgular: Tüm değerlendirmelerde Gözlemci-1 için gözlemci içi ICC 0,861 ile 0,973 aralığında, Gözlemci-2 için 0,893 ile 0,993 aralığındaydı. Birinci değerlendirmeler dikkate alındığında gözlemciler arası ICC 0,865-0,961 aralığındaydı. Bu veriler her iki gözlemci için gözlemci içi ve gözlemciler arası mükemmel uyumu temsil ediyordu (P<0.001).
Sonuç: Preoperatif BT taraması, özellikle x-ray’e göre stabil (AO/OTA-31A1) olarak değerlendirilen intertrokanterik kırıklarda tedavide implant tercihi için tanısal bir yarar sağlayabilir. Her ne kadar BT tarama analizi sonuçları mükemmel olsada, bu görüntüleme yöntemi cerrahi prosedürü planlamak ve optimize etmek için duruma göre kullanılmalıdır.
Keywords
İntertrokanterik kırık İmplant tercihi gözlemciler-arası tutarlılık Optimize cerrahi prosedür
References
- Reference1 Mnif H, Koubaa M, Zrig M, Trabelsi R, Abid A. Elderly patient’s mortality and morbidity following a trochanteric fracture. A prospective study of 100 cases. Orthopaedics & traumatology, surgery & research. 2009;95:505-510.
- Reference2 Haidukewych GJ. Intertrochanteric fractures: ten tips to improve results. JBJS. 2009;91:712-719.
- Reference3 Kokoroghiannis C, Aktselis I, Deligeorgis A, Fragkomichalos E, Papadimas D, Pappadas I. Evolving concepts of stability and intramedullary fixation of intertrochanteric fractures—a review. Injury. 2012;43:686-693.
- Reference4 Sonawane DV. Classifications of intertrochanteric fractures and their clinical importance. Trauma Int. 2015;1(1):7-11.
- Reference5 Jensen JS. Classification of trochanteric fractures. Acta orthopaedica Scandinavica. 1980;51:803-810.
- Reference6 Bucholz RW. The Comprehensive Classification of Fractures of Long Bones. JBJS. 1991;73:636-637.
- Reference7 Fung W, Jönsson A, Buehren V, Bhandari M. Classifying intertrochanteric fractures of the proximal femur: does experience matter?. Medical Principles and Practice. 2007;16:198-202.
- Reference8 van Embden D, Rhemrev SJ, Meylaerts SA, Roukema GR. The comparison of two classifications for trochanteric femur fractures: the AO/ASIF classification and the Jensen classification. Injury. 2010;41:377-381.
- Reference9 Schipper IB, Steyerberg EW, Castelein RM, Vugt AB. Reliability of the AO/ASIF classification for pertrochanteric femoral fractures. Acta Orthopaedica Scandinavica. 2001;72:36-41.
- Reference10 Pervez H, Parker MJ, Pryor GA, Lutchman L, Chirodian N. Classification of trochanteric fracture of the proximal femur: a study of the reliability of current systems. Injury. 2002;33:713-715.
- Reference11 Isida R, Bariatinsky V, Kern G, Dereudre G, Demondion X, Chantelot C. Prospective study of the reproducibility of X-rays and CT scans for assessing trochanteric fracture comminution in the elderly: a series of 110 cases. European Journal of Orthopaedic Surgery & Traumatology. 2015;25:1165-1170.
- Reference12 Brunner A, Honigmann P, Treumann T, Babst R. The impact of stereo-visualisation of three-dimensional CT datasets on the inter-and intraobserver reliability of the AO/OTA and Neer classifications in the assessment of fractures of the proximal humerus. The Journal of Bone and Joint Surgery. British volume. 2009;9:766-771.
- Reference13 Humphrey CA, Dirschl DR, Ellis TJ. Interobserver reliability of a CT-based fracture classification system. Journal of orthopaedic trauma. 2005;19:616-622.
- Reference14 Han SK, Lee BY, Kim YS, Choi NY. Usefulness of multi-detector CT in Boyd-Griffin type 2 intertrochanteric fractures with clinical correlation. Skeletal radiology. 2010;39:543-549.
- Reference15 Sonawane DV. Classifications of intertrochanteric fractures and their clinical importance. Trauma Int. 2015;1:7-11.
- Reference16 Jin WJ, Dai LY, Cui YM, Zhou Q, Jiang LS, Lu H. Reliability of classification systems for intertrochanteric fractures of the proximal femur in experienced orthopaedic surgeons. Injury. 2005;36:858-861.
- Reference17 Miedel R, Ponzer S, Törnkvist H, Söderqvist A, Tidermark J. The standard Gamma nail or the Medoff sliding plate for unstable trochanteric and subtrochanteric fractures: a randomised, controlled trial. The Journal of Bone and Joint Surgery. British volume. 2005;87:68-75.
- Reference18 Kukla C, Heinz T, Gaebler C, Heinze G, Vécsei V. The standard Gamma nail: a critical analysis of 1,000 cases. Journal of Trauma and Acute Care Surgery. 2001;51:77-83.
- Reference19 Apel DM, Patwardhan AV, Pinzur MS, Dobozi WR. Axial loading studies of unstable intertrochanteric fractures of the femur. Clinical orthopaedics and related research. 1989;246:156-64.
- Reference20 Konishi N, Sato K. Three-dimensional observations of trochanteric fractures of the femur. Nihon Seikeigeka Gakkai Zasshi. 1987;61:97-106.
- Reference21 Cavaignac E, Lecoq M, Ponsot A, Moine A, Bonnevialle N, Mansat P, Sans N, Bonnevialle P. CT scan does not improve the reproducibility of trochanteric fracture classification: a prospective observational study of 53 cases. Orthopaedics & Traumatology: Surgery & Research. 2013;99:46-51.
- Reference22 Palm H, Lysén C, Krasheninnikoff M, Holck K, Jacobsen S, Gebuhr P. Intramedullary nailing appears to be superior in pertrochanteric hip fractures with a detached greater trochanter: 311 consecutive patients followed for 1 year. Acta orthopaedica. 2011;82:166-70.
Does Computed Tomography Provide an Advantage over X-ray in the Treatment of Intertrochanteric Fractures?
Abstract
Objective: Successful treatment of intertrochanteric fractures depends on an appropriate implant and is decided according to fracture classification and stability. In the present study, the purpose was to investigate the interobserver and intraobserver consistency of x-ray and/or Computed Tomography (CT) in fracture classification and implant preference for treatment in intertrochanteric fractures.
Materials and Methods: The patients who were diagnosed with 80 intertrochanteric fractures by two orthopedists with 5 or more years of trauma experience and who had pelvic CT scans for suspected accompanying fractures were evaluated in the study. AO/OTA classification and implant preference for treatment were based on x-ray and/or CT. Second evaluations were made two weeks later. Cohen’s Kappa was calculated for interobserver reliability in the first evaluation and intraobserver reliability in the first and second evaluations.
Results: Intra-observer ICC ranged between 0.861 and 0.973 for Observer-1 and between 0.893 and 0.993 for Observer-2 in all evaluations. Inter-observer ICC was within the range of 0.865-0.961 based on primary evaluations. These data represented excellent intra- and inter-observer consistency for both observers (P<0.001).
Conclusion: Preoperative CT scans may provide diagnostic benefits for implant preference, especially in intertrochanteric fractures evaluated as stable (AO/OTA-31A1) according to x-ray. Although CT scan analysis results are excellent, this imaging modality should be used on a case-by-case basis to plan and optimize surgical procedures.
Keywords
Intertrochanteric fracture Implant preference Inter-observer consistency Optimize surgical procedures
References
- Reference1 Mnif H, Koubaa M, Zrig M, Trabelsi R, Abid A. Elderly patient’s mortality and morbidity following a trochanteric fracture. A prospective study of 100 cases. Orthopaedics & traumatology, surgery & research. 2009;95:505-510.
- Reference2 Haidukewych GJ. Intertrochanteric fractures: ten tips to improve results. JBJS. 2009;91:712-719.
- Reference3 Kokoroghiannis C, Aktselis I, Deligeorgis A, Fragkomichalos E, Papadimas D, Pappadas I. Evolving concepts of stability and intramedullary fixation of intertrochanteric fractures—a review. Injury. 2012;43:686-693.
- Reference4 Sonawane DV. Classifications of intertrochanteric fractures and their clinical importance. Trauma Int. 2015;1(1):7-11.
- Reference5 Jensen JS. Classification of trochanteric fractures. Acta orthopaedica Scandinavica. 1980;51:803-810.
- Reference6 Bucholz RW. The Comprehensive Classification of Fractures of Long Bones. JBJS. 1991;73:636-637.
- Reference7 Fung W, Jönsson A, Buehren V, Bhandari M. Classifying intertrochanteric fractures of the proximal femur: does experience matter?. Medical Principles and Practice. 2007;16:198-202.
- Reference8 van Embden D, Rhemrev SJ, Meylaerts SA, Roukema GR. The comparison of two classifications for trochanteric femur fractures: the AO/ASIF classification and the Jensen classification. Injury. 2010;41:377-381.
- Reference9 Schipper IB, Steyerberg EW, Castelein RM, Vugt AB. Reliability of the AO/ASIF classification for pertrochanteric femoral fractures. Acta Orthopaedica Scandinavica. 2001;72:36-41.
- Reference10 Pervez H, Parker MJ, Pryor GA, Lutchman L, Chirodian N. Classification of trochanteric fracture of the proximal femur: a study of the reliability of current systems. Injury. 2002;33:713-715.
- Reference11 Isida R, Bariatinsky V, Kern G, Dereudre G, Demondion X, Chantelot C. Prospective study of the reproducibility of X-rays and CT scans for assessing trochanteric fracture comminution in the elderly: a series of 110 cases. European Journal of Orthopaedic Surgery & Traumatology. 2015;25:1165-1170.
- Reference12 Brunner A, Honigmann P, Treumann T, Babst R. The impact of stereo-visualisation of three-dimensional CT datasets on the inter-and intraobserver reliability of the AO/OTA and Neer classifications in the assessment of fractures of the proximal humerus. The Journal of Bone and Joint Surgery. British volume. 2009;9:766-771.
- Reference13 Humphrey CA, Dirschl DR, Ellis TJ. Interobserver reliability of a CT-based fracture classification system. Journal of orthopaedic trauma. 2005;19:616-622.
- Reference14 Han SK, Lee BY, Kim YS, Choi NY. Usefulness of multi-detector CT in Boyd-Griffin type 2 intertrochanteric fractures with clinical correlation. Skeletal radiology. 2010;39:543-549.
- Reference15 Sonawane DV. Classifications of intertrochanteric fractures and their clinical importance. Trauma Int. 2015;1:7-11.
- Reference16 Jin WJ, Dai LY, Cui YM, Zhou Q, Jiang LS, Lu H. Reliability of classification systems for intertrochanteric fractures of the proximal femur in experienced orthopaedic surgeons. Injury. 2005;36:858-861.
- Reference17 Miedel R, Ponzer S, Törnkvist H, Söderqvist A, Tidermark J. The standard Gamma nail or the Medoff sliding plate for unstable trochanteric and subtrochanteric fractures: a randomised, controlled trial. The Journal of Bone and Joint Surgery. British volume. 2005;87:68-75.
- Reference18 Kukla C, Heinz T, Gaebler C, Heinze G, Vécsei V. The standard Gamma nail: a critical analysis of 1,000 cases. Journal of Trauma and Acute Care Surgery. 2001;51:77-83.
- Reference19 Apel DM, Patwardhan AV, Pinzur MS, Dobozi WR. Axial loading studies of unstable intertrochanteric fractures of the femur. Clinical orthopaedics and related research. 1989;246:156-64.
- Reference20 Konishi N, Sato K. Three-dimensional observations of trochanteric fractures of the femur. Nihon Seikeigeka Gakkai Zasshi. 1987;61:97-106.
- Reference21 Cavaignac E, Lecoq M, Ponsot A, Moine A, Bonnevialle N, Mansat P, Sans N, Bonnevialle P. CT scan does not improve the reproducibility of trochanteric fracture classification: a prospective observational study of 53 cases. Orthopaedics & Traumatology: Surgery & Research. 2013;99:46-51.
- Reference22 Palm H, Lysén C, Krasheninnikoff M, Holck K, Jacobsen S, Gebuhr P. Intramedullary nailing appears to be superior in pertrochanteric hip fractures with a detached greater trochanter: 311 consecutive patients followed for 1 year. Acta orthopaedica. 2011;82:166-70.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Articles |
| Authors | |
| Publication Date | September 29, 2022 |
| Submission Date | March 15, 2022 |
| Published in Issue | Year 2022 Volume: 12 Issue: 3 |
The published articles in SMJ are licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.