Abstract
Introduction
It is not known how the described methods of reduction and dynamic hip screw (DHS) fixation of displaced intracapsular femoral neck fractures translate into proper assessment of the postoperative radiographs. At teaching or evaluation sessions in daily practice, frequent discussion arises about postoperative technical assessment. The assessment of correct reduction and DHS fixation using the described methods in the literature may be subject to differences between observers. The aim of this study was to assess the extent of inter- and intraobserver agreement on technique, based on the methods in the literature, in a simulated daily practice setting.
Materials and methods
The postoperative anteroposterior (AP) and lateral radiographs of 35 randomly selected patients aged 60–90 years were rated twice, 2 months apart, by six surgical observers from three institutions with similar views on reduction and DHS fixation for this fracture type. The radiographs were of sufficient quality for proper assessment. Criteria for reduction and fixation could be rated as either adequate or inadequate. An adequate rating was assigned if in the observer’s opinion, regardless of likely outcome, technical perfection according to the described methods had been achieved. The kappa statistic was calculated as a measure of agreement.
Results
Fracture reduction on the AP view approached a good kappa value (0.54). Poor to moderate interobserver agreement was found for fracture reduction on the lateral view and aspects of DHS fixation (kappa 0.10–0.36). Intraobserver agreement was good for five out of six observers for reduction and DHS fixation aspects (kappa 0.51–0.81).
Conclusion
During routine practice six surgical observers can nearly agree on adequate fracture reduction on the AP view, but do not agree on adequate reduction on the lateral view and adequate DHS fixation on the postoperative radiographs of displaced intracapsular femoral neck fractures.
Similar content being viewed by others
References
Altman DG (1999) Practical statistics for medical research. Chapman and Hall, London
Baumgaertner MR, Curtin SL, Lindskog DM et al (1995) The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am 77:1058–1064
Bjorgul K, Reikeras O (2002) Low interobserver reliability of radiographic signs predicting healing disturbance in displaced intracapsular hip fracture of the femoral neck. Acta Orthop Scand 73:307–310
Bosch U, Schreiber T, Krettek C (2002) Reduction and fixation of intracapsular fractures of the proximal femur. Clin Orthop 399:59–71
Bout CA, Cannegieter DM, Juttman JW (1997) Percutaneous cannulated screw fixation of femoral neck fractures: the three point principle. Injury 28:135–139
Chua D, Jaglal SB, Schatzker J (1998) Predictors of early failure of fixation in the treatment of displaced subcapital hip fractures. J Orthop Trauma 12:230–234
Deneka DA, Simonian PT, Stankewich CJ et al (1997) Biomechanical comparison of internal fixation techniques for the treatment of unstable basocervical femoral neck fractures. J Orthop Trauma 11:337–343
Fleiss JL (2000) Statistical methods for rates and proportions. John Wiley, New York, pp 212–36
Garden RS (1961) Low-angle fixation in fractures of the femoral neck. J Bone Joint Surg Br 48:647–663
Garden RS (1971) Malreduction and avascular necrosis in subcapital fractures of the femur. J Bone Joint Surg Br 53:183–197
Gomez-Castresana F, Caballer AP, Portal LF (2002) Avascular necrosis of the femoral head after femoral neck fracture. Clin Orthop 399:87–109
Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174
Luitse JSK, Dunki Jacobs PB, Hart CP van der (1993) The Dynamic Hip Screw; golden standard in the treatment of pertrochanteric fractures? In: Marti RK, Dunki Jacobs PB (eds) Proximal femoral fractures. Medical Press, London, pp 409–22
McElvenny RT (1945) Roentgenographic interpretation of what constitutes adequate reduction of femoral neck fractures. Surg Gyn Obst 80:97–106
Parker MJ (1994) Prediction of fracture union after internal fixation of intracapsular femoral neck fractures. Injury 25:3–6
Parker MJ, Blundell C (1998) Choice of implant for internal fixation of femoral neck fractures. Acta Orthop Scand 69:138–143
Parker MJ (2000) The management of intracapsular fractures of the proximal femur. J Bone Joint Surg Br 82:937–941
Pauwels F (1935) Der schenkelhalsbruch. Ein mechanisches problem. Supplement to Z Orthop Chir 63. Enke Stuttgart
Swiontkowski MF (1994) Current concepts review: intracapsular fractures of the hip. J Bone Joint Surg Am 76:129–138
Acknowledgements
We wish to thank our observers and reviewers: William Ertl, MD, Ian Harris, FRACS (Orth), Sean E. Nork, MD, R.P. Poolman, MD, and Professor DJ Gouma, PhD.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Heetveld, M.J., Raaymakers, E.L.F.B., van Walsum, A.D.P. et al. Observer assessment of femoral neck radiographs after reduction and dynamic hip screw fixation. Arch Orthop Trauma Surg 125, 160–165 (2005). https://doi.org/10.1007/s00402-004-0780-4
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00402-004-0780-4