Acetabular fracture assessment in four different pelvic trauma centers: have the Judet views become superfluous?
BACKGROUND
The present study was designed to examine whether oblique radiographs (Judet views) in addition to 2D and 3D CT scans improved the intra- and interobserver reliability when assessing acetabular fractures.


METHODS
Four international orthopedic pelvic trauma centers reviewed the radiological images for 20 acetabular fracture patients. Three different image sets were made; one set containing plain radiographs including oblique (Judet) views and 2D axial CT scans. The second set contained an AP radiograph of the pelvis, without oblique views, 2D and 3D CT scans. The third set contained all the images. The image sets were evaluated in three separate sessions, for each session the raters were asked to classify the fracture according to Letournel, as well as record a number of other important radiological features concerning the fracture.


RESULTS
The interobserver agreement for the Letournel classification was found to be moderate for all image sets. The image set without oblique views showed the best agreement with a kappa value of 0.60. The intra- and interobserver agreement for important modifiers were found to be substantial. The addition of oblique radiographs did not seem to increase the intra- or interobserver agreement for any of the factors evaluated except for the roof arc score.


CONCLUSIONS
The moderate agreement found for the Letournel classification is to be expected given the complexity of the classification. The addition of oblique radiographs to the image sets does not seem to improve the reliability and thus its routine use for classification and decision making may be debated.
Division of Surgery and Clinical Neuroscience, Orthopeadic Department, Oslo University Hospital, Nydalen, PO Box 4956, Oslo, Norway, Johcla@getmail.no.
John
J
Clarke-Jenssen
Stein Arne
SA
Øvre
Olav
O
Røise
Jan Erik
JE
Madsen
D000077:Acetabulum / Q000000981:diagnostic imaging / Q000293:injuries*; D000328:Adult; D005260:Female; D006620:Hip Fractures / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D009664:Norway; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000592:standards*; D014193:Trauma Centers / Q000706:statistics & numerical data