Aggarwal Amit, Singh Mahipal, Aggarwal Aditya N, Bhatt Shuchi
Department of Orthopaedics, University College of Medical Sciences, Guru Teg Bahadur Hospital, Delhi 110095, India.
Chin J Traumatol. 2014 Apr 1;17(2):99-102.
To assess the interobserver agreement on Garden classification of fresh femoral neck fracture and management plan based on anteroposterior (AP) view and also assess if the addition of lateral view changes the classification and management plan.
Ten orthopaedic surgeons were asked to classify 35 femoral neck fractures on AP view only and propose the management plan. Then the same films were reshown in conjunction with their lateral view after 10 days. Results were compared with respect to the classification and management plan between two groups. Interobserver agreement was calculated using Fleiss' kappa.
There was only a fair interobserver agreement (kappa value 0.39) on Garden classification on AP view only which improved to moderate agreement (kappa value 0.52) after adding a lateral view. While there was only a slight improvement in the interobserver agreement on the management plan on AP view only (kappa value 0.50) and AP combined with lateral views (kappa value 0.52). Supplementation of the lateral view changed the classification in 15.42% of the cases and altered the management plan in 23.14% of the cases.
We conclude that lateral view should be obtained routinely on all patients with suspected femoral neck fracture as it definitely has a role in planning treatment of femoral neck fracture.
基于前后位（AP）X线片评估不同观察者对新鲜股骨颈骨折Garden分型及处理方案的一致性，并评估增加侧位X线片是否会改变骨折分型及处理方案。
邀请10名骨科医生仅根据AP位X线片对35例股骨颈骨折进行分型并提出处理方案。10天后，将相同的X线片与侧位片一起重新展示给他们。比较两组在骨折分型和处理方案方面的结果。采用Fleiss' kappa计算观察者间的一致性。
仅根据AP位X线片进行Garden分型时，观察者间一致性一般（kappa值为0.39），增加侧位片后一致性提高至中等（kappa值为0.52）。仅根据AP位X线片制定处理方案时观察者间一致性略有提高（kappa值为0.50），AP位片结合侧位片时一致性为（kappa值为0.52）。补充侧位片后，15.42%的病例骨折分型发生改变，23.14%的病例处理方案发生改变。
我们得出结论，对于所有疑似股骨颈骨折的患者，应常规拍摄侧位X线片，因为其在股骨颈骨折治疗方案的制定中确实具有重要作用。
