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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2013 April;64(2):147-54
The influence of traction internal rotation radiograph on the classification and treatment options of intertrochanteric femoral fractures
Bilsel K., Erdil M., Elmadag M., Erzincanli A., Gurkan V., Tuncay I., Sen C. ✉
Orthopedic and Traumatology Department, Bezmialem Vakif University, Istanbul, Turkey
Aim: In this prospective randomized study with intraobserver and interobserver assessment, we aimed to compare the classifications and operative decisions of intertrochanteric fractures realized by orthopedic surgeons with standard radiographs and traction internal rotation radiographs by intraobserver and interobserver assessment.
Methods: Sixty-two intertrochanteric femur fractures were evaluated for Evans-Jensen classification and for 3 treatment options as dynamic hip screw (DHS), proximal femoral nailing (PFN) and arthroplasty, with standard and traction internal rotation radiographs and randomized for intraobserver and interobserver assessment of two professors and three orthopedic attending surgeons.
Results; Inter-rater agreement for classification decision data was very good in standard radiograph group and in traction radiograph group. However, inter-rater agreement for treatment options were fair in standard radiograph and poor in traction radiograph group. In the evaluation of intraobserver agreement, the classification decision of surgeons made with standard radiographs varied significantly after traction internal rotation radiographs of the same patients. Also the treatment options were significantly different for all surgeons in standard and traction internal rotation radiographs of the same patients whereas the surgeons tended to osteosynthesis after traction internal rotation radiographs.
Conclusion: We conclude that traction internal rotation radiograph which is a simple and an applicable method in the orthopedic trauma practice can change the orthopedic surgeon’s decision of classification of the fracture and surgery type.