Abstract
OBJECTIVES: The aim of this study was to evaluate the intrarater and interrater reliability of a scoring system for internal fixation (SIFA) in undisplaced femoral neck fractures (FNF).
DESIGN: A reproducibility study with a historical consecutive cohort.
SETTING: The patients were all treated at a level one trauma hospital.
PATIENTS/PARTICIPANTS: A cohort of patients with FNF, treated with 2 parallel implants, was retrieved using a local county register, and the cohort was assessed for undisplaced FNF until the desired sample size was reached. One hundred two patients had their x-ray images reviewed 2 times with a minimum 14 days interval, by 3 raters, all blinded for each other's results, and an independent person analyzed the data with unweighted kappa statistics.
MAIN OUTCOME MEASUREMENTS: Implant positions on the first postoperative anterior-posterior and axial radiographs were first visually assessed, then objectively measured according to SIFA, which consists of 5 individual measurements; screw tip distance, screw femoral shaft angle, inferior screw calcar distance, and screw position in the femoral head in the anterior-posterior and axial radiographs.
RESULTS: Visually assessed implant position gave intrarater kappa results for the individual components of SIFA at 0.40-0.75 (rater 1), 0.75-0.98 (rater 2), and 0.69-0.83 (rater 3), with interrater kappa results at 0.18-0.80 (combined range). Objectively measured implant position for the individual components of SIFA gave intrarater kappa results at 0.56-1.0 (rater 1), 0.74-0.89 (rater 2), and 0.81-0.94 (rater 3), with interrater kappa results at 0.56-0.85 (combined range). The overall SIFA score has similar higher intrarater and interrater results for the measured (0.51-0.78) compared with the visual assessment (0.13-0.78). The assessment in the axial view of the screw position in femoral head had the largest difference of acceptable positioning, when comparing visual assessment with the measured.
CONCLUSIONS: The SIFA demonstrates substantial intrarater and interrater reliability (kappa 0.51-0.78), when raters make measurements of radiographs, but lower reliability (kappa 0.13-0.78) when raters visually assess the radiographs without measuring. The SIFA should be assessed on a large cohort, for correlation with clinical evaluation.
| Originalsprog | Engelsk |
|---|---|
| Tidsskrift | Journal of Orthopaedic Trauma |
| Vol/bind | 30 |
| Udgave nummer | 8 |
| Sider (fra-til) | 432-6 |
| Antal sider | 5 |
| ISSN | 0890-5339 |
| DOI | |
| Status | Udgivet - 1 aug. 2016 |