Are lateral view radiographs necessary to properly classify femoral neck fractures? Intra and interobserver analysis using Garden's classification system
INTRODUCTION: Femoral neck fractures have been historically diagnosed by anteroposterior (AP) and lateral (L) radiographic views. We analyzed the importance of the L view for management of femoral neck fractures, using the Garden's classification system. MATERIALS AND METHODS: Slides were elabo...
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| Formato: | Artículo revista |
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Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
2021
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| Acceso en línea: | https://revistas.unc.edu.ar/index.php/med/article/view/30732 |
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I10-R327-article-30732 |
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ojs |
| institution |
Universidad Nacional de Córdoba |
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I-10 |
| repository_str |
R-327 |
| container_title_str |
Revista de la Facultad de Ciencias Médicas de Córdoba |
| language |
Español |
| format |
Artículo revista |
| topic |
hip hip fractures hip prosthesis hip injuries radiography cadera fracturas de cadera prótesis de cadera lesiones de la cadera radiografía quadril fraturas do quadril prótese de quadril lesões do quadril radiografia |
| spellingShingle |
hip hip fractures hip prosthesis hip injuries radiography cadera fracturas de cadera prótesis de cadera lesiones de la cadera radiografía quadril fraturas do quadril prótese de quadril lesões do quadril radiografia Novillo, Matías Díaz Dilernia, Fernando García Barreiro, Gonzalo Posadas-Martinez, Maria Lourdes Comba, Fernando Buttaro, Martin Are lateral view radiographs necessary to properly classify femoral neck fractures? Intra and interobserver analysis using Garden's classification system |
| topic_facet |
hip hip fractures hip prosthesis hip injuries radiography cadera fracturas de cadera prótesis de cadera lesiones de la cadera radiografía quadril fraturas do quadril prótese de quadril lesões do quadril radiografia |
| author |
Novillo, Matías Díaz Dilernia, Fernando García Barreiro, Gonzalo Posadas-Martinez, Maria Lourdes Comba, Fernando Buttaro, Martin |
| author_facet |
Novillo, Matías Díaz Dilernia, Fernando García Barreiro, Gonzalo Posadas-Martinez, Maria Lourdes Comba, Fernando Buttaro, Martin |
| author_sort |
Novillo, Matías |
| title |
Are lateral view radiographs necessary to properly classify femoral neck fractures? Intra and interobserver analysis using Garden's classification system |
| title_short |
Are lateral view radiographs necessary to properly classify femoral neck fractures? Intra and interobserver analysis using Garden's classification system |
| title_full |
Are lateral view radiographs necessary to properly classify femoral neck fractures? Intra and interobserver analysis using Garden's classification system |
| title_fullStr |
Are lateral view radiographs necessary to properly classify femoral neck fractures? Intra and interobserver analysis using Garden's classification system |
| title_full_unstemmed |
Are lateral view radiographs necessary to properly classify femoral neck fractures? Intra and interobserver analysis using Garden's classification system |
| title_sort |
are lateral view radiographs necessary to properly classify femoral neck fractures? intra and interobserver analysis using garden's classification system |
| description |
INTRODUCTION: Femoral neck fractures have been historically diagnosed by anteroposterior (AP) and lateral (L) radiographic views. We analyzed the importance of the L view for management of femoral neck fractures, using the Garden's classification system.
MATERIALS AND METHODS: Slides were elaborated with AP and L radiographic views of 100 patients with femoral neck fractures admitted to our emergency department. Three hip surgeons assessed independently AP views only and then AP and L views together using Garden's classification system.
RESULTS: No statistically significant differences (Kruskal Wallis 0, p=1) were found while comparing categories among Garden's classification system, after assessing L views. There was an 81 % (p < 0.001) agreement of Garden category between AP and AP combined with L views. When analyzing patients with changing categories between displaced and non displaced after assessing L view images, we found a 5% (n=5, CI 95% 1-11%) of change. For comparing AP Garden with L view Garden, we used a quadratic weighted kappa method.
CONCLUSIONS: There is a high agreement in the Garden category when comparing AP with combined AP and L observations. Five patients would have received a different surgical treatment dependent on the hip surgeon who assessed the radiographs. This highlights the relevance of routinely L radiographs whenever a femoral neck fracture is suspected.
Keywords: hip; hip fractures; hip prosthesis; hip injuries; radiography |
| publisher |
Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología |
| publishDate |
2021 |
| url |
https://revistas.unc.edu.ar/index.php/med/article/view/30732 |
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I10-R327-article-307322021-07-07T13:29:31Z Are lateral view radiographs necessary to properly classify femoral neck fractures? Intra and interobserver analysis using Garden's classification system ¿Es necesaria la incidencia radiográfica de perfil para clasificar las fracturas mediales de cadera? Análisis intra e inter observador utilizando la clasificación de Garden ¿As radiografias de perfil são necessárias para classificar corretamente as fraturas do colo do fêmur? Análise intra e interobservador usando o sistema de classificação de Garden Novillo, Matías Díaz Dilernia, Fernando García Barreiro, Gonzalo Posadas-Martinez, Maria Lourdes Comba, Fernando Buttaro, Martin hip hip fractures hip prosthesis hip injuries radiography cadera fracturas de cadera prótesis de cadera lesiones de la cadera radiografía quadril fraturas do quadril prótese de quadril lesões do quadril radiografia INTRODUCTION: Femoral neck fractures have been historically diagnosed by anteroposterior (AP) and lateral (L) radiographic views. We analyzed the importance of the L view for management of femoral neck fractures, using the Garden's classification system. MATERIALS AND METHODS: Slides were elaborated with AP and L radiographic views of 100 patients with femoral neck fractures admitted to our emergency department. Three hip surgeons assessed independently AP views only and then AP and L views together using Garden's classification system. RESULTS: No statistically significant differences (Kruskal Wallis 0, p=1) were found while comparing categories among Garden's classification system, after assessing L views. There was an 81 % (p < 0.001) agreement of Garden category between AP and AP combined with L views. When analyzing patients with changing categories between displaced and non displaced after assessing L view images, we found a 5% (n=5, CI 95% 1-11%) of change. For comparing AP Garden with L view Garden, we used a quadratic weighted kappa method. CONCLUSIONS: There is a high agreement in the Garden category when comparing AP with combined AP and L observations. Five patients would have received a different surgical treatment dependent on the hip surgeon who assessed the radiographs. This highlights the relevance of routinely L radiographs whenever a femoral neck fracture is suspected. Keywords: hip; hip fractures; hip prosthesis; hip injuries; radiography INTRODUCCIÓN: Históricamente, el diagnóstico de una fractura medial de cadera requiere de una radiografía anteroposterior (AP) y de perfil (P). Nos propusimos analizar la importancia de la radiografía de perfil en la evaluación y planificación del tratamiento de las fracturas mediales de cadera, utilizando la clasificación de Garden. MATERIALES Y MÉTODOS: Se prepararon diapositivas con radiografías AP y de P de 100 pacientes con fracturas mediales de cadera admitidos en nuestra central de emergencias. Tres cirujanos de cadera evaluaron de forma independiente las incidencias AP únicamente y luego las vistas AP y P, utilizando la clasificación de Garden. RESULTADOS: Se utilizó el método de Kruskal Wallis para comparar los rangos en la clasificación de Garden después de ver la proyección de P y no se encontraron diferencias estadísticamente significativas (Kruskal Wallis 0, p=1). El acuerdo ponderado entre AP y el AP combinado con el P del Garden promedio fue de 81 % (p < 0.001). Se analizó el porcentaje de pacientes recategorizados entre fracturas no desplazadas y desplazadas, tras observar el perfil: 5% (n=5, IC 95% 1-11%) . Para comparar el Garden AP con el Garden P, se utilizó el método kappa ponderado cuadrático. CONCLUSIONES: Existe una alta concordancia en la clasificación de Garden al comparar las observaciones de las radiografías AP, con las observaciones AP y P juntas. Cinco pacientes hubiesen recibido un tratamiento quirúrgico diferente dependiendo del especialista que interpretaba las radiografías. Esto permite destacar la importancia de solicitar la incidencia de perfil de rutina en pacientes con sospecha de fractura medial de cadera. palabras clave: cadera; fracturas de cadera; prótesis de cadera; lesiones de la cadera; radiografía INTRODUÇÃO: Historicamente, o diagnóstico de uma fratura medial de quadril requer uma radiografia ântero-posterior (AP) e de perfil (P). Propusemo-nos a analisar a importância da radiografia de perfil na avaliação e planejamento do tratamento das fraturas mediais do quadril, utilizando a classificação de Garden. MATERIAIS E MÉTODOS: As lâminas foram preparadas com radiografias AP e P de 100 pacientes com fratura medial do quadril admitidos em nosso centro de emergência. Três cirurgiões de quadril avaliaram independentemente apenas os eventos AP e, em seguida, as visualizações AP e P, usando a classificação de Garden. RESULTADOS: O método de Kruskal Wallis foi usado para comparar as classificações na classificação de Garden após a visualização da projeção P e não foram encontradas diferenças estatisticamente significativas (Kruskal Wallis 0, p = 1). A concordância ponderada entre AP e AP combinada com a média do Garden P foi de 81% (p <0,001). Foi analisada a porcentagem de pacientes reclassificados em fraturas sem deslocamento e com deslocamento, após observação do perfil: 5% (n = 5, IC 95% 1-11%). Para comparar o Garden AP com o Garden P, foi utilizado o método kappa quadrático ponderado. CONCLUSÕES: Há alta concordância na classificação de Garden ao comparar as observações radiográficas AP com as observações AP e P juntas. Cinco pacientes teriam recebido um tratamento cirúrgico diferente dependendo do especialista que interpretou as radiografias. Isso destaca a importância de solicitar a incidência do perfil de rotina em pacientes com suspeita de fratura medial de quadril. Palavras-chave: quadril; fraturas do quadril; prótese de quadril; lesões do quadril; radiografia Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2021-03-29 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion text/html application/pdf https://revistas.unc.edu.ar/index.php/med/article/view/30732 10.31053/1853.0605.v78.n1.30732 Revista de la Facultad de Ciencias Médicas de Córdoba.; Vol. 78 No. 1 (2021); 41-44 Revista de la Facultad de Ciencias Médicas de Córdoba; Vol. 78 Núm. 1 (2021); 41-44 Revista da Faculdade de Ciências Médicas de Córdoba; v. 78 n. 1 (2021); 41-44 1853-0605 0014-6722 10.31053/1853.0605.v78.n1 spa https://revistas.unc.edu.ar/index.php/med/article/view/30732/33294 https://revistas.unc.edu.ar/index.php/med/article/view/30732/33296 Derechos de autor 2021 Universidad Nacional de Córdoba http://creativecommons.org/licenses/by-nc/4.0 |