Orthopaedic Trauma Service, Division of Orthopaedic Surgery, University of Cape Town, Groote Schuur Hospital, University of Cape Town, H49 Old Main Building, Observatory, Cape Town, 7925, RSA.
Trauma Care & Injury Prevention, Division of Global Surgery, University of Cape Town, Cape Town, RSA.
Eur J Orthop Surg Traumatol. 2024 Aug;34(6):2981-2986. doi: 10.1007/s00590-024-04015-4. Epub 2024 Jun 7.
Numerous classification systems have been developed for neck of femur fractures, but none have been tested for reliability in gunshot injuries. Our primary objective was to assess the inter-observer and intra-observer reliability of the AO/OTA classification system when applied to intracapsular neck of femur fractures secondary to low-velocity civilian gunshots wounds (GSWs). Our secondary objective was to test the reliability of the AO/OTA classification system in guiding surgeon treatment choices for these fractures.
Eighteen reviewers (six orthopaedic traumatologists, six general orthopaedic surgeons and six junior orthopaedic fellows) were given a set of 25 plain radiographs and CT scans of femur neck fractures secondary to GSW. For each clinical case, all reviewers selected a classification as well as treatment option from a list of given options. Inter-observer reliability was measured at the initial classification. The exercise was repeated 10-12 weeks later by the same 18 reviewers to test intra-observer reliability.
The Fleiss kappa values indicate only slight agreement amongst raters, across all experience levels, for both injury classification and treatment. Intra-observer agreement was fair across all experience levels for both injury classification and treatment.
The AO/OTA classification showed only slight reliability in classification of gunshot fractures of the femur neck. With only fair reliability, it also failed to guide surgical treatment thus rendering its routine use in daily clinical practice of questionable value.
已经开发出许多用于股骨颈骨折的分类系统，但没有一个系统经过测试可以用于评估低速民用枪支射击伤所致关节囊内股骨颈骨折的可靠性。我们的主要目标是评估 AO/OTA 分类系统在用于评估低速民用枪支射击伤所致关节囊内股骨颈骨折时的观察者间和观察者内可靠性。我们的次要目标是测试 AO/OTA 分类系统在指导此类骨折的外科治疗选择方面的可靠性。
18 名评估者（6 名创伤骨科医生、6 名普通骨科医生和 6 名初级骨科住院医师）获得了一组 25 例股骨颈骨折的 X 线和平扫及 CT 扫描图像，这些骨折继发于民用低速枪支射击伤。对于每个临床病例，所有评估者都从给定的治疗选项列表中选择分类和治疗方案。最初的分类评估采用观察者间可靠性。18 名评估者在 10-12 周后重复进行相同的练习，以测试观察者内可靠性。
Fleiss kappa 值表明，在所有经验水平下，评估者在损伤分类和治疗方面的一致性仅为轻度。在所有经验水平下，观察者内一致性在损伤分类和治疗方面均为中等。
AO/OTA 分类在股骨颈枪击伤骨折的分类中仅显示出轻度可靠性。由于可靠性仅为中等，它也未能指导手术治疗，因此其在日常临床实践中的常规使用价值值得怀疑。
