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. 2025 Apr 7;33(spe1):e279781.
doi: 10.1590/1413-785220243201e279781. eCollection 2025.

TROCHANTERIC FRACTURES: ARE THE CLASSIFICATIONS RELIABLE?

Luis Henrique Zambra Win  1 , Oliver Damiani Meyer  1 , Eduardo Pedrini Cruz  1 , Ivan Simionato  1 , Carlos Roberto Schwartsmann  1 , Fernanda Coutinho Kubaski  1
Affiliations

TROCHANTERIC FRACTURES: ARE THE CLASSIFICATIONS RELIABLE?

Luis Henrique Zambra Win et al. Acta Ortop Bras. .

Abstract
in English, Portuguese

Objective: To evaluate classification use based on the assessment of agreement in trochanteric fractures between different observers through a simple proposal of bimodal classification.

Methodology: A total of 50 radiographic images of femur trochanteric fractures were selected and classified by 22 evaluators, 10 traumatologists and 12 residents, as STABLE or UNSTABLE. The assessment of reproducibility was done using the kappa statistical index. After the evaluation, the groups were isolated and submitted to the ANOVA test with Bonferroni correction to evaluate the statistical differences between them.

Results: When evaluated by the kappa index, the results of the 50 fractures assessed by the 22 evaluators were k = 0.272. The reproducibility of the classification proposal was considered statistically weak.

Conclusion: Based on this study, it is recommended that the classifications be extensively tested and reach a minimum level of interobserver reproducibility (kappa > 0.8). It is suggested that classifications that do not achieve this result be improved or abandoned. Level of evidence II, Prospective study.

Objetivo: Avaliar a utilização das classificações a partir da avaliação de concordância nas fraturas trocantéricas entre diferentes observadores através de uma proposta simples de classificação bimodal.

Métodos: Foram selecionadas 50 imagens radiográficas de fraturas trocantéricas do fêmur e classificadas por 22 avaliadores, sendo 10 traumatologistas e 12 residentes que definiram as fraturas como ESTÁVEIS ou INSTÁVEIS. A avaliação da reprodutibilidade foi dada pelo índice estatístico Kappa. Após a avaliação, os grupos foram isolados e submetidos ao teste ANOVA com correção Bonferroni para avaliar as diferenças estatísticas entre eles.

Resultados: Quando submetidos a avaliação pelo índice Kappa os resultados das 50 fraturas avaliadas pelos 22 avaliadores foi de k = 0,272. A reprodutibilidade da proposta de classificação foi considerada estatisticamente fraca.

Conclusão: A partir deste estudo recomenda-se que as classificações sejam extensamente testadas e atinjam um nível mínimo de reprodutibilidade (Kappa > 0,8) interobservadores. Sugere-se que as classificações que não atinjam este resultado sejam aprimoradas ou abandonadas. Nível de evidencia II, Estudo prospectivo.

Keywords: Classification; Interobserver agreement; Reliability; Trochanteric fracture.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1. Image of the 50 radiographs used for the assessment.
Graph 1
Graph 1. Histogram of the variation and concentration of kappa indices among traumatologists
Graph 2
Graph 2. Histogram of the variation and concentration of kappa indices among R3
Graph 3
Graph 3. Histogram of the variation and concentration of kappa indices among R1 + R2
Graph 4
Graph 4. Histogram of the variation and concentration of kappa indices among all observers
Graph 5
Graph 5. Graph presenting each group’s kappa coefficient with 95% CI, demonstrating that the traumatologists group had a statistically significant difference in relation to the other groups (p = 0.007)
See this image and copyright information in PMC

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