Effectiveness validation of a novel comprehensive classification for intertrochanteric fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 CUI Lukuan ^1,2 , LIU Hao ^2,3 , WANG Jiangjing ^2,4 , FAN Huanhuan ^2,5 , WANG Dapeng ^2,3 , WANG Shuhui ^2,3 , SONG Chi ^2,3

1. Department of Bone and Soft Tissue Oncology, Cangzhou Hospital of Integrated TCM-WM·Hebei, Cangzhou Hebei, 061000, P. R. China;
2. Hebei Key Laboratory of Integrated Traditional and Western Medicine in Osteoarthrosis Research, Cangzhou Hebei, 061000, P. R. China;
3. Department of Upper Limb Trauma, Cangzhou Hospital of Integrated TCM-WM·Hebei, Cangzhou Hebei, 061000, P. R. China;
4. Department of 2nd Orthopedic Surgery, Cangzhou Hospital of Integrated TCM-WM·Hebei, Cangzhou Hebei, 061000, P. R. China;
5. Department of 2nd Foot and Ankle Surgery, Cangzhou Hospital of Integrated TCM-WM·Hebei, Cangzhou Hebei, 061000, P. R. China;

Corresponding author：

CUI Lukuan, Email: liziyi20051400@163.com

Keywords：

Intertrochanteric fracture; classification; effectiveness; consistency

DOI：

10.7507/1002-1892.202211117

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Objective To validate the effectiveness of a novel comprehensive classification for intertrochanteric fracture (ITF). Methods The study included 616 patients with ITF, including 279 males (45.29%) and 337 females (54.71%); the age ranged from 23 to 100 years, with an average of 72.5 years. Two orthopaedic residents (observers Ⅰ and Ⅱ) and two senior orthopaedic surgeons (observers Ⅲ and Ⅳ) were selected to classify the CT imaging data of 616 patients in a random order by using the AO/Orthopaedic Trauma Association (AO/OTA) classification of 1996/2007 edition, the AO/OTA classification of 2018 edition, and the novel comprehensive classification method at an interval of 1 month. Kappa consistency test was used to evaluate the intra-observer and inter-observer consistency of the three ITF classification systems. Results The inter-observer consistency of the three classification systems evaluated by 4 observers twice showed that the 3 classification systems had strong inter-observer consistency. Among them, the κ value of the novel comprehensive classification was higher than that of the AO/OTA classification of 1996/2007 edition and 2018 edition, and the experience of observers had a certain impact on the classification results, and the inter-observer consistency of orthopaedic residents was slightly better than that of senior orthopaedic surgeons. The intra-observer consistency of two evaluations of three classification systems by 4 observers showed that the consistency of the novel comprehensive classification was better for the other 3 observers, except that the consistency of observer Ⅳ in the AO/OTA classification of 2018 version was slightly higher than that of the novel comprehensive classification. The results showed that the novel comprehensive classification has higher repeatability, and the intra-observer consistency of senior orthopaedic surgeons was better than that of orthopaedic residents. Conclusion The novel comprehensive classification system has good intra- and inter-observer consistency, and has high validity in the classification of CT images of ITF patients; the experience of observers has a certain impact on the results of the three classification systems, and those with more experiences have higher intra-observer consistency.

Citation： CUI Lukuan, LIU Hao, WANG Jiangjing, FAN Huanhuan, WANG Dapeng, WANG Shuhui, SONG Chi. Effectiveness validation of a novel comprehensive classification for intertrochanteric fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(4): 417-422. doi: 10.7507/1002-1892.202211117 Copy

1.	Zarie M, Mohamoud MF, Farhoud AR, et al. Evaluation of the inter and intra-observer reliability of the AO classification of intertrochanteric fractures and the device choice (DHS, PFNA, and DCS) of fixations. Ethiop J Health Sci, 2020, 30(5): 755-760.
2.	Su H, Liu H, Liu J, et al. Elderly patients with intertrochanteric fractures after intramedullary fixation: Analysis of risk factors for calf muscular vein thrombosis. Orthopade, 2018, 47(4): 341-346.
3.	Kumar P, Rajnish RK, Sharma S, et al. Proximal femoral nailing is superior to hemiarthroplasty in AO/OTA A2 and A3 intertrochanteric femur fractures in the elderly: a systematic literature review and meta-analysis. Int Orthop, 2020, 44(4): 623-633.
4.	张世民, 胡孙君, 杜守超, 等. 股骨转子间骨折一种新的综合分类法. 中国修复重建外科杂志, 2022, 36(9): 1056-1063.
5.	Olczak J, Emilson F, Razavian A, et al. Ankle fracture classification using deep learning: automating detailed AO Foundation/Orthopedic Trauma Association (AO/OTA) 2018 malleolar fracture identification reaches a high degree of correct classification. Acta Orthop, 2021, 92(1): 102-108.
6.	Trompeter AJ, Furness H, Kanakaris NK, et al. Classification of open fractures: the need to modernize. Bone Joint J, 2020, 102-B(11): 1431-1434.
7.	Klaber I, Besa P, Sandoval F, et al. The new AO classification system for intertrochanteric fractures allows better agreement than the original AO classification. An inter- and intra-observer agreement evaluation. Injury, 2021, 52(1): 102-105.
8.	Chan G, Hughes K, Barakat A, et al. Inter- and intra-observer reliability of the new AO/OTA classification of proximal femur fractures. Injury, 2021, 52(6): 1434-1437.
9.	Yin B, He Y, Wang D, et al. Classification of femur trochanteric fracture: Evaluating the reliability of Tang classification. Injury, 2021, 52(6): 1500-1505.
10.	Urrutia J, Zamora T, Besa P, et al. Inter and intra-observer agreement evaluation of the AO and the Tronzo classification systems of fractures of the trochanteric area. Injury, 2015, 46(6): 1054-1058.
11.	van Embden D, Rhemrev SJ, Meylaerts SA, et al. The comparison of two classifications for trochanteric femur fractures: the AO/ASIF classification and the Jensen classification. Injury, 2010, 41(4): 377-381.
12.	Hsu CE, Huang KC, Lin TC, et al. Integrated risk scoring model for predicting dynamic hip screw treatment outcome of intertrochanteric fracture. Injury, 2016, 47(11): 2501-2506.
13.	Hsu CE, Shih CM, Wang CC, et al. Lateral femoral wall thickness. A reliable predictor of post-operative lateral wall fracture in intertrochanteric fractures. Bone Joint J, 2013, 95-B(8): 1134-1138.
14.	Busato TS, Baldasso D, Matioski Filho GR, et al. Evaluation of the intraobserver and interobserver agreements of the new AO/OTA classification for fractures of the trochanteric region and the femoral neck. Rev Bras Ortop (Sao Paulo), 2021, 57(2): 241-249.
15.	Yıldırım C, Muratoğlu OG, Turan K, et al. The intra- and interobserver reliability of five commonly used intertrochanteric femur fracture classification systems. Jt Dis Relat Surg, 2022, 33(1): 187-192.
16.	尹博, 周君琳, 何远铭, 等. 股骨转子间骨折三维新分型的可靠性分析. 中华创伤骨科杂志, 2020, 22(1): 55-59.
17.	Kyle RF, Gustilo RB, Premer RF. Analysis of six hundred and twenty-two intertrochanteric hip fractures. J Bone Joint Surg (Am), 1979, 61(2): 216-221.
18.	Shoda E, Kitada S, Sasaki Y, et al. Proposal of new classification of femoral trochanteric fracture by three-dimensional computed tomography and relationship to usual plain X-ray classification. J Orthop Surg (Hong Kong), 2017, 25(1): 2309499017692700. doi: 10.1177/2309499017692700.
19.	Kijima H, Yamada S, Konishi N, et al. The reliability of classifications of proximal femoral fractures with 3-dimensional computed tomography: the new concept of comprehensive classification. Adv Orthop, 2014, 2014: 359689. doi: 10.1155/2014/359689.
20.	徐龙, 林清宇, 王宝虎, 等. 股骨粗隆间骨折AO分型对围手术期隐性失血的影响. 第二军医大学学报, 2017, 38(7): 951-953.

1. Zarie M, Mohamoud MF, Farhoud AR, et al. Evaluation of the inter and intra-observer reliability of the AO classification of intertrochanteric fractures and the device choice (DHS, PFNA, and DCS) of fixations. Ethiop J Health Sci, 2020, 30(5): 755-760.
2. Su H, Liu H, Liu J, et al. Elderly patients with intertrochanteric fractures after intramedullary fixation: Analysis of risk factors for calf muscular vein thrombosis. Orthopade, 2018, 47(4): 341-346.
3. Kumar P, Rajnish RK, Sharma S, et al. Proximal femoral nailing is superior to hemiarthroplasty in AO/OTA A2 and A3 intertrochanteric femur fractures in the elderly: a systematic literature review and meta-analysis. Int Orthop, 2020, 44(4): 623-633.
4. 张世民, 胡孙君, 杜守超, 等. 股骨转子间骨折一种新的综合分类法. 中国修复重建外科杂志, 2022, 36(9): 1056-1063.
5. Olczak J, Emilson F, Razavian A, et al. Ankle fracture classification using deep learning: automating detailed AO Foundation/Orthopedic Trauma Association (AO/OTA) 2018 malleolar fracture identification reaches a high degree of correct classification. Acta Orthop, 2021, 92(1): 102-108.
6. Trompeter AJ, Furness H, Kanakaris NK, et al. Classification of open fractures: the need to modernize. Bone Joint J, 2020, 102-B(11): 1431-1434.
7. Klaber I, Besa P, Sandoval F, et al. The new AO classification system for intertrochanteric fractures allows better agreement than the original AO classification. An inter- and intra-observer agreement evaluation. Injury, 2021, 52(1): 102-105.
8. Chan G, Hughes K, Barakat A, et al. Inter- and intra-observer reliability of the new AO/OTA classification of proximal femur fractures. Injury, 2021, 52(6): 1434-1437.
9. Yin B, He Y, Wang D, et al. Classification of femur trochanteric fracture: Evaluating the reliability of Tang classification. Injury, 2021, 52(6): 1500-1505.
10. Urrutia J, Zamora T, Besa P, et al. Inter and intra-observer agreement evaluation of the AO and the Tronzo classification systems of fractures of the trochanteric area. Injury, 2015, 46(6): 1054-1058.
11. van Embden D, Rhemrev SJ, Meylaerts SA, et al. The comparison of two classifications for trochanteric femur fractures: the AO/ASIF classification and the Jensen classification. Injury, 2010, 41(4): 377-381.
12. Hsu CE, Huang KC, Lin TC, et al. Integrated risk scoring model for predicting dynamic hip screw treatment outcome of intertrochanteric fracture. Injury, 2016, 47(11): 2501-2506.
13. Hsu CE, Shih CM, Wang CC, et al. Lateral femoral wall thickness. A reliable predictor of post-operative lateral wall fracture in intertrochanteric fractures. Bone Joint J, 2013, 95-B(8): 1134-1138.
14. Busato TS, Baldasso D, Matioski Filho GR, et al. Evaluation of the intraobserver and interobserver agreements of the new AO/OTA classification for fractures of the trochanteric region and the femoral neck. Rev Bras Ortop (Sao Paulo), 2021, 57(2): 241-249.
15. Yıldırım C, Muratoğlu OG, Turan K, et al. The intra- and interobserver reliability of five commonly used intertrochanteric femur fracture classification systems. Jt Dis Relat Surg, 2022, 33(1): 187-192.
16. 尹博, 周君琳, 何远铭, 等. 股骨转子间骨折三维新分型的可靠性分析. 中华创伤骨科杂志, 2020, 22(1): 55-59.
17. Kyle RF, Gustilo RB, Premer RF. Analysis of six hundred and twenty-two intertrochanteric hip fractures. J Bone Joint Surg (Am), 1979, 61(2): 216-221.
18. Shoda E, Kitada S, Sasaki Y, et al. Proposal of new classification of femoral trochanteric fracture by three-dimensional computed tomography and relationship to usual plain X-ray classification. J Orthop Surg (Hong Kong), 2017, 25(1): 2309499017692700. doi: 10.1177/2309499017692700.
19. Kijima H, Yamada S, Konishi N, et al. The reliability of classifications of proximal femoral fractures with 3-dimensional computed tomography: the new concept of comprehensive classification. Adv Orthop, 2014, 2014: 359689. doi: 10.1155/2014/359689.
20. 徐龙, 林清宇, 王宝虎, 等. 股骨粗隆间骨折AO分型对围手术期隐性失血的影响. 第二军医大学学报, 2017, 38(7): 951-953.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness validation of a novel comprehensive classification for intertrochanteric fractures

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