title: The value of CT compared to radiographs in the classification and treatment plan of trochanteric fractures.
abstract: BACKGROUND
  The clinical relevance of classification for trochanteric fractures is limited and little agreement exists on what type of implant should be used. It is unknown whether more advanced radio-diagnostics, such as CT, result in better agreement on the treatment. We assessed the effect of CT on agreement of classification and subsequent treatment for trochanteric fractures.
  
  
  METHODS
  Eleven observers (five radiologists, four trauma surgeons and two orthopedic residents) assessed 30 radiographs and CTs of trochanteric fractures. Each rating included an assessment according to the AO classification and of the preferred type of implant. The inter-observer agreement of the AO classification and on the choice of implant was calculated.
  
  
  RESULTS
  The inter-observer agreement was κ0.70 (SE 0.03) for radiographic assessment of the main groups of the AO classification and κ0.68 (SE 0.03) for CT assessment. The agreement on choice of implant was κ0.63 (SE 0.05) if the choice was made with radiographs and κ0.69 (SE 0.05) with CTs. Six out of the 13 fractures were classified differently after assessment of the CT. Most corrections in choice of implant occurred for the assessment of A3 fractures.
  
  
  CONCLUSIONS
  This study confirmed that trochanteric fractures can be reliably classified on both radiographs and CT, according to the main groups of the AO classification. The implementation of CT for trochanteric fractures does not lead to higher agreement on fracture classification or choice of treatment. Therefore, the clinical relevance of CT for classification of trochanteric fractures seems low. For specific subgroups such as A3 fractures, CT may be of value for adequate fracture classification and subsequent treatment strategies.
authors.affiliation: Department of Surgery, Medisch Centrum Haaglanden Bronovo, Lijnbaan 32, 2512 VA, The Hague, The Netherlands. d.van.embden@mchaaglanden.nl.
authors.forename: D
authors.initials: D
authors.lastname: van Embden
authors.affiliation: Department of Radiology, Medisch Centrum Haaglanden Bronovo, The Hague, The Netherlands.
authors.forename: M M
authors.initials: MM
authors.lastname: Scheurkogel
authors.affiliation: Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: I B
authors.initials: IB
authors.lastname: Schipper
authors.affiliation: Department of Surgery, Medisch Centrum Haaglanden Bronovo, Lijnbaan 32, 2512 VA, The Hague, The Netherlands.
authors.forename: S J
authors.initials: SJ
authors.lastname: Rhemrev
authors.affiliation: Department of Surgery, Medisch Centrum Haaglanden Bronovo, Lijnbaan 32, 2512 VA, The Hague, The Netherlands.
authors.forename: S A G
authors.initials: SA
authors.lastname: Meylaerts
mesh_terms: D000368:Aged; D000066491:Clinical Decision-Making; D005260:Female; D006620:Hip Fractures / Q000145:classification / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008297:Male; D015588:Observer Variation; D000072161:Orthopedic Surgeons; D000072177:Radiologists; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed; D014194:Traumatology
keywords: Agreement; Classification; Hip fracture; Treatment; Trochanteric