Inter- and Intra-Observer Reliability of the New Comprehensive Classification of Intertrochanteric Fracture of the Femur.

Abstract

Objective: To evaluate the reliability of the new Comprehensive Classification in clinical practice by comparing it with Evans-Jensen (1975), AO/OTA (2007), and AO/OTA (2018).

Methods: A total of 192 patients with intertrochanteric fractures were included in the study. The fractures were classified using the Comprehensive Classification system and the three traditional methods by eight observers, consisting of four high-experienced and four less-experienced surgeons. Interobserver and intraobserver agreements were assessed using kappa statistics and compared across the different classification systems.

Results: The study included 192 patients. The average inter-observer Kappa values using CT scan for Evans-Jensen (1975), AO/OTA (2007), AO/OTA (2018), and Comprehensive Classification were 0.361 ± 0.06, 0.348 ± 0.05, 0.408 ± 0.06, and 0.492 ± 0.02, respectively. The average inter-observer Kappa values based on 3DR were 0.411 ± 0.04, 0.396 ± 0.03, 0.442 ± 0.03, and 0.524 ± 0.03, respectively. The average intra-observer Kappa values using CT scan were 0.467 ± 0.05, 0.453 ± 0.06, 0.542 ± 0.04, and 0.631 ± 0.02, respectively. The average intra-observer Kappa values using 3DR were 0.503 ± 0.05, 0.482 ± 0.03, 0.561 ± 0.03, and 0.672 ± 0.02, respectively. The mean kappa value of Inter- and intra-observer for the Comprehensive Classification were higher than Evans-Jensen (1975) and AO/OTA (2007/2018) using CT scans and 3DR (P < 0.05). Additionally, the high-experienced group using 3DR had the highest agreement, at approximately 75.86%, when comparing the implant type corresponding to the fracture classification evaluated by the observer with the implant type selected by the observer.

Conclusion: The Comprehensive Classification system emerges as a reliable and superior tool for the classification of intertrochanteric fractures, offering improved agreement rates and practical treatment insights compared to traditional methods. This classification has guiding significance for treatment.