Evaluation the Reliability of Singh Index in Elderly Patients with Proximal Femoral Fractures Using Digital Radiographic Image / 대한정형외과연구학회지

PURPOSE: To evaluate the reliability of Singh index (SI) values, determined on image software processed digital radiographs in elderly patients with proximal femoral fractures, with respect to its value as a simple and inexpensive method to evaluate osteoporosis in acute trauma situations. MATERIALS AND METHODS: The authors retrospectively reviewed 210 patients (98 femur neck fractures, 112 intertrochanter fractures) treated between March 2005 and March 2009. Preoperative digital radiographs of each patient were assessed by four observers to determine SI values. The reliability of SI was expressed in terms of intraobserver and interobserver agreements in pairs using Fleiss's overall Kappa, Stuart's tau-c index, and Kendall's coefficiency of concordance. RESULTS: Fleiss's overall kappa values for intraobserver agreement ranged from 0.278 to 0.586 (mean, 0.452) and did not reach good reliability overall. Fleiss's overall kappa values for interobserver agreement ranged from 0.120 to 0.241 (mean, 0.180), and thus, did not reach acceptable reliability. CONCLUSION: The result suggest that the image adjustment tools provided by digital radiography cannot improve the usefulness of SI as a simple and inexpensive method of assessing the osteoporosis. Therefore, the reliability of SI good enough to be used for clinical and research work is questionable.

Surgical Treatment of Dorsally Displaced Unstable Distal Radius Fracture with Volar Plate Fixation / 대한정형외과학회잡지

PURPOSE: This study was performed to evaluate the usefulness of volar plate fixation of dorsally displaced unstable distal radius fracture. MATERIALS AND METHODS: 48 patients with dorsally displaced unstable distal radius fracture were treated by volar plate fixation, between August 1993 and February 2003. Radial inclination, radial length and volar tilting were analyzed by radiographic evaluation. For clinical evaluation, the clinical ratings of Green and O'Brien were used. RESULTS: Radiographic analysis of extra-articular or non-comminuted intra-articular fractures (AO type A2, A3, and C1) demonstrated no significant differences in radial inclination, radial height and volar tilting between the immediate postoperative period and the last follow-up evaluation. However, in cases of comminuted intra-articular fractures (AO type C2), there were statistically significant differences. In clinical evaluation, 40 (83%) patients demonstrated excellent or good results based on the clinical ratings of Green and O'Brien. 32 (94%) of patients demonstrated excellent or good results in extra-articular (AO type A2 and A3) or non-comminuted intra-articular fractures (AO type C1) and 8 (57%) patients demonstrated excellent or good results in comminuted intra-articular fractures (AO type C2). The number of patients with complications was 4 (8%). Median nerve neuropathy developed in 2 patients, and hand and wrist stiffness in 2 patients. All cases achieved bony union. There was no implant failure or irritation. CONCLUSION: Volar plate fixation of extra-articular or non-comminuted intra-articular fractures (AO type A2, A3, and C1) was an effective treatment method for dorsally displaced unstable distal radius fractures. It provided stable fixation and allowed early postoperative rehabilitation.