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Treatment of adult femoral neck fracture is still a great challenge faced by trauma orthopedists. As treatment effects can be infleunced by multiple factors, like age, gender and preoperative physical condition, they may vary with different treatment schemes. Classification of femoral neck fractures plays an important guiding role in choosing a proper treatment scheme and judging the prognosis. The current classic clinical classification systems for femoral neck fractures include Garden, AO/OTA and Pauwels classifications. Since the recent progress in science and technology has put more advanced technologies into clinic application, such as CT, MRI and Digital Subtraction Angiography (DSA), new ways of classification have appeared. However, each classification has its own shortcomings which need to be improved. This paper reviews the research progress in classification of adult femoral neck fractures and their treatment principles.
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Background: To evaluate radiological and functional outcome in fractures of the distal radius treated by K-wire fixation.Methods: Forty patients (16 males, 24 females) with different types of fractures of distal radius were treated. K-wire fixation was performed under axillary bolock or general anaesthesia. Anatomical restoration was evaluated by postero-anterior and lateral radiographs obtained preoperatively and at 09 months of follow up to evaluate Radial Height (RH), Radial Inclination (RI) and Volar Tilt (VT). Functional outcome was evaluated using Mayo scoring system.Results: According to Mayo score 72.5% (n=29) of our patients had excellent to good outcome while as 17.5% (n=7) had fair outcome and 10% (n=4) patients had poor outcome.Conclusions: Kirschner wire fixation is an inexpensive procedure that provides anatomic reduction, fracture fixation, and maintenance of reduction with an adequate method of immobilization.
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ABSTRACT Objective: To evaluate the inter and intraobserver agreement of the Magerl AO and AOSpine thoracolumbar fracture classification systems. Methods: The participants were divided into two groups, the first composed of six spinal surgeons and the other composed of 18 medical orthopedic residents. On two different occasions, separated by an interval of one month, the participants analyzed and classified 25 radiographs with thoracolumbar fractures using both thoracolumbar fracture classification systems, Magerl AO and AOSpine. The results were analyzed for classification reliability using the Kappa coefficient (k). Results: The Magerl AO classification system showed a fair interobserver agreement (k = 0.32), considering the fractures type and subtype, whereas the AOSpine classification system showed a moderate interobserver agreement (k = 0.59). The Magerl AO classification showed a fair intraobserver agreement for both residents and specialists (k = 0.21 and 0.38, respectively), while the AOSpine showed a substantial agreement between residents (k = 0.62) and moderate between specialists (k = 0.53). Conclusions: When evaluating fracture morphology, the AOSpine thoracolumbar fracture classification system presented a better reliability and reproducibility compared to the Magerl AO classification system.
RESUMO Objetivo: Avaliar a concordância inter e intraobservadores dos sistemas de classificação Magerl AO e AOSpine para fraturas toracolombares. Métodos: Os participantes foram divididos em dois grupos, um com seis médicos ortopedistas especialistas em coluna e o outro com 18 médicos residentes em ortopedia. Os participantes analisaram 25 radiografias com fraturas toracolombares em duas oportunidades, com um mês de intervalo entre elas, e classificaram com o uso dos dois sistemas de classificação de fratura toracolombar, Magerl AO e AOSpine. Os dados de concordância foram analisados pelo método do coeficiente kappa. Resultados: A classificação de Magerl AO apresentou uma concordância interobservadores leve (k = 0,32), considerando o tipo e o subtipo das fraturas, enquanto a classificação AOSpine obteve uma concordância interobservadores moderada (k = 0,59). A classificação de Magerl AO apresentou uma concordância intraobservadores leve entre médicos residentes e médicos especialistas (k = 0,21 e 0,38, respectivamente), enquanto a classificação AOSpine apresentou uma boa concordância intraobservadores entre médicos residentes (k = 0,62) e moderada entre médicos especialistas (k = 0,53). Conclusão: O sistema de classificação da AOSpine para fraturas toracolombares apresentou uma melhor confiabilidade e reprodutibilidade comparado com o sistema de classificação Magerl AO, em relação à morfologia da fratura.
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Humans , Male , Female , Spinal Injuries , Observer VariationABSTRACT
Objective To compare the diagnostic reliability of AO classification and Evans-Jensen classifications in X ray film and three-dimensional CT reconstruction images intertochanteric fractures, and explore advantage of the three-di?mensional CT. Methods A retrospective study was performed to evaluate 54 patients with intertochanteric fractures. Three orthopaedic surgeons were asked to make assessment of fracture classifications using X ray film and the three-dimen?sional CT images. Agreement test was performed to evaluate interobserver and intraobserver reliability for fracture classifica?tion. Results When X ray film was used, mean Kappa values of interobserver reliability for AO and Evans-Jensen classifi?cations between three surgeons were 0.597 and 0.571, that was medium consistency. While using three-dimensional CT to AO classification, lower Kappa value was 0.411, medium consistency. Evans-Jensen classification, Kappa value was 0.704, highly consistency. Each surgeon respectively using X ray film and three-dimensional CT, the mean Kappa values of AO and Evans-Jensen classification were 0.464, medium consistency and 0.191 (0.160-0.233), weak consistency. Conclusion Both classifications based on X ray film show moderate consistency, using three-dimensional CT does not improve the consis?tency of AO classification. The three-dimensional CT is not applicable in Evans-Jensen classification.
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[Objective]To summarize efficiency evaluation of treatment for tibial plateau fracture,to select optimal treatment for tibial plateau fracture in clinical practice.[Method]Retrospective analysis of 138 patients of tibial plateau fracture in our hospital from January 1999 to January 2003.They were all fresh fracture within 2 weeks after trauma,79 cases male 59 cases female,age 15~76,average 43.5 yrs.95 cases complicated with ligament and meniscus injure in knee joint.according to B 1,B2 were treat with manipulative reduction,traction AO classification and sinking degree,they were divided into type B and type C.type and external fixation of splint.Type B3,C1 were treated with prize-up replacement,grafting and internal fixation with screws.Type C2,C3 were treated with firm internal plate fixation.[Result]133 cases were followed up for 6~36months in 138 cases of tibial plateau fracture,average 23 months.Recovery of knee function were divided according to KDLMERI classification.Type B1B2B3 excellent rate 100%.C1 excellent 14cases,fair 2 cases.C2 excellent 10 cases,fair 8 cases.C3 excellent 6cases,fair 3 cases,badly 2 cases.Recovery of knee fruction excellent 118 cases(88.7%),fair and spoor 15cases(11.3%).[Conclusion]sinking degree of articular surface must be emphasized in treatment oftibial plateau fracture.Satisfied therapy effect can be obtained with early function exercise of knee joint.