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Reliability of Fracture Neck of Femur Classification Systems

Lookup NU author(s): Oday Al-Dadah


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Introduction: Fractured neck of femur (NOF) is a common injury, and the majority occur in the elderly frail population. Classification systems are useful in helping guide management and determine prognosis, therefore having a reliable system is of clinical benefit. In the literature, two main classification systems exist for NOF, Garden and Pauwel’s, but there is debate over which is more reliable. The aim of this study was to compare the reliability of Garden and Pauwel’s classification systems for intra-capsular NOF.Methods: Two observers (A and B), both fourth year medical students, independently evaluated anteroposterior pelvis X-rays of patients with an intra-capsular NOF on two separate occasions, three weeks apart. Each X-ray was graded using both Garden and Pauwel’s classification systems. The data was statistically analysed to determine the inter- and intra-observer reliability of each system through kappa (k) values and intra-class correlation coefficients.Results: Forty-five x-rays in total were analysed. Pauwel’s classification showed greater interobserver reliability on both the first (k=0.56, p<0.001) and the second assessment (k=0.46, p<0.001) when compared to Garden (k=0.22, p=0.027 and k=0.33, p=0.002) respectively. Pauwel’s demonstrated higher levels of intra-observer reliability for observer A (k=0.81, p<0.001) when compared to Garden (k=0.71, p<0.001). However, there was a negligible difference in intra-observer reliability for observer B, with values for Pauwel’s and Gardens of k=0.47 (p=0.002) and k=0.46 (p<0.001) respectively.Conclusions: Pauwel’s classification had higher inter-observer reliability and higher intra-observer reliability for observer A but there was negligible intra-observer difference between the systems for observer B. Pauwel’s is a more reproducible system for use with intra-capsular NOF than Garden’s classification.

Publication metadata

Author(s): Baron OA, Peggie EM, Al-Dadah O

Publication type: Article

Publication status: Published

Journal: Journal of the Student Association of Medical Research

Year: 2020

Volume: 4

Issue: 1

Pages: 61-62

Print publication date: 27/12/2020

Acceptance date: 27/09/2020

Publisher: National Student Association of Medical Research (NSAMR)