title: The reliability of classifications of proximal femoral fractures with 3-dimensional computed tomography: the new concept of comprehensive classification.
abstract: The reliability of proximal femoral fracture classifications using 3DCT was evaluated, and a comprehensive "area classification" was developed. Eleven orthopedists (5-26 years from graduation) classified 27 proximal femoral fractures at one hospital from June 2013 to July 2014 based on preoperative images. Various classifications were compared to "area classification." In "area classification," the proximal femur is divided into 4 areas with 3 boundary lines: Line-1 is the center of the neck, Line-2 is the border between the neck and the trochanteric zone, and Line-3 links the inferior borders of the greater and lesser trochanters. A fracture only in the first area was classified as a pure first area fracture; one in the first and second area was classified as a 1-2 type fracture. In the same way, fractures were classified as pure 2, 3-4, 1-2-3, and so on. "Area classification" reliability was highest when orthopedists with varying experience classified proximal femoral fractures using 3DCT. Other classifications cannot classify proximal femoral fractures if they exceed each classification's particular zones. However, fractures that exceed the target zones are "dangerous" fractures. "Area classification" can classify such fractures, and it is therefore useful for selecting osteosynthesis methods.
authors.affiliation: Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan ; Akita Hip Research Group, Akita 010-8543, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kijima
authors.affiliation: Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan ; Akita Hip Research Group, Akita 010-8543, Japan.
authors.forename: Shin
authors.identifier: 0000-0002-3386-4636
authors.initials: S
authors.lastname: Yamada
authors.affiliation: Akita Hip Research Group, Akita 010-8543, Japan.
authors.forename: Natsuo
authors.initials: N
authors.lastname: Konishi
authors.affiliation: Akita Hip Research Group, Akita 010-8543, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kubota
authors.affiliation: Akita Hip Research Group, Akita 010-8543, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tazawa
authors.affiliation: Akita Hip Research Group, Akita 010-8543, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Tani
authors.affiliation: Akita Hip Research Group, Akita 010-8543, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Suzuki
authors.affiliation: Akita Hip Research Group, Akita 010-8543, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Kamo
authors.affiliation: Akita Hip Research Group, Akita 010-8543, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Okudera
authors.affiliation: Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan ; Akita Hip Research Group, Akita 010-8543, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Sasaki
authors.affiliation: Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan ; Akita Hip Research Group, Akita 010-8543, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Kawano
authors.affiliation: Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan ; Akita Hip Research Group, Akita 010-8543, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Shimada