Avaliação das concordâncias intra e interobservadores da nova classificação AO/OTA para fraturas da região trocantérica e do colo do fêmur

Busato, Thiago Sampaio; Baldasso, Daniel; Filho, Gladyston Roberto Matioski; Godoi, Lucas Dias; Morozowski, Marcelo Gavazzoni; Capriotti, Juan Rodolfo Vilela

doi:10.1055/s-0041-1729939

Cited by 3 publications

(4 citation statements)

References 27 publications

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“…However, prior studies have demonstrated only moderate interobserver agreement on 31-A3 subgroups, with Kappa generally in the fair range. 24 25) Despite attempts to refine the system, variability in radiographic interpretation remains. While we used an experienced surgeon reader, fracture classification reliability was a limitation without multiple blinded observers.…”

Section: Discussionmentioning

confidence: 99%

Intertrochanteric (Reverse Oblique) Fracture Subclassifications AO/OTA 31-A3 Have No Effect on Outcomes or Postoperative Complications

Factor,

Elbaz,

Kazum

et al. 2024

Clin Orthop Surg

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Background Reverse oblique intertrochanteric fractures (ROFs) are unstable extracapsular hip fractures that present a mechanical challenge. These fractures are classified as AO/Orthopaedic Trauma Association (OTA) 31-A3 according to the Trauma Association classification system and can further be subclassified into 3 subtypes based on their specific characteristics. The study aimed to evaluate and compare the radiographic and clinical outcomes of the 3 subtypes of ROFs. Methods A retrospective study was conducted at a single high-volume, tertiary center, where data were collected from electronic medical records of consecutive patients who underwent surgical fixation of AO/OTA 31-A3 fractures. Patients with less than 1-year follow-up, pathological fractures, and revision surgery were excluded. The subtypes of fractures were classified as 31-A3.1 (simple oblique), 31-A3.2 (simple transverse), and 31-A3.3 (wedge or multi-fragmentary). The operation was done using 4 different fixation methods, and radiological evaluation was performed at routine intervals. Results The final population consisted of 265 patients (60.8% women) with a mean age of 77.4 years (range, 50–100 years) and the mean follow-up time was 35 months (range, 12–116 months). The incidence of medical complications was similar across the groups. However, there was a trend toward a higher incidence of orthopedic complications and revision rates in the 31-A3.2 group, although this was not statistically significant ( p = 0.21 and p = 0.14, respectively). Conclusions Based on the findings of this study, no significant differences were observed between the groups, indicating that the subclassifications of AO/OTA 31-A3 fractures do not have a significant impact on surgical outcomes or the occurrence of postoperative complications.

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Section: Discussionmentioning

confidence: 99%

Intertrochanteric (Reverse Oblique) Fracture Subclassifications AO/OTA 31-A3 Have No Effect on Outcomes or Postoperative Complications

Factor,

Elbaz,

Kazum

et al. 2024

Clin Orthop Surg

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“…In addition, like the Gustilo-Anderson classification system, 2 other groups have criticized the OTA-OFC as only exhibiting moderate interobserver grading agreement, particularly among junior surgeons. 3,4 It also remains unclear which OTA-OFC categories overlap with the Gustilo-Anderson classification or add unique value for clinical decision making.…”

Section: Introductionmentioning

confidence: 99%

Does the OTA Open Fracture Classification Align With the Gustilo-Anderson Classification? A Study of 2215 Open Fractures

Kovvur,

Turner,

Lawrence

et al. 2023

Journal of Orthopaedic Trauma

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OBJECTIVES: To characterize the Orthopaedic Trauma Association Open Fracture Classification (OTA-OFC) and Gustilo-Anderson classification of open extremity fractures and determine if there is meaningful alignment between these grading systems. METHODS: Design : Retrospective case series. Setting : Level I academic trauma center. Patient Selection Criteria : Adult patients with at least one operatively treated open extremity fracture and surgeon-assigned OTA-OFC and Gustilo-Anderson classification. Outcome Measures and Comparisons : Frequency, distribution, and association measures of OTA-OFC category scores and Gustilo-Anderson classification types. RESULTS: 2027 patients (mean age, 43.1 ± 17.5 years) with 2215 fractures were included. Gustilo-Anderson Type I or II fractures (n = 961; 43%) most frequently had the least severe scores for all OTA-OFC categories. Type IIIA fractures (n = 978; 44%) were most often assigned intermediate scores for OTA-OFC Bone Loss (n = 564; 58%). Type IIIB fractures (n = 204, 9%) were most often assigned intermediate OTA-OFC Skin scores (n = 120; 59%). Type IIIC fractures (n = 72; 3%) were most often assigned the most severe OTA-OFC Arterial score (n = 60; 83%). In the multivariable model, OTA-OFC Contamination scores showed little association (β = 0.05; 95% confidence interval [CI], 0.01–0.09) with Gustilo-Anderson classification severity. Conversely, higher OTA-OFC Arterial (β = 0.50; 95% CI, 0.44–0.56) and Skin (β = 0.46; 95% CI, 0.40–0.51) scores were strongly associated with more severe Gustilo-Anderson classifications. CONCLUSIONS: OTA-OFC Contamination scores were weakly associated with Gustilo-Anderson classification severity for open fractures. The study findings suggest the current Gustilo-Anderson classification does not adequately account for injury contamination, a known predictor of infection.

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“…Today, orthopedic surgeons must be aware of 3D-CT, based on the analysis of three-dimensional fragments, for a better classification of fractures of the proximal femur since it better evaluates fragmentation and instability and has better interobserver and interobserver reliability than conventional twodimensional systems, even for AO/OTA classification [20]. The current version, revised in 2018, has provided acceptable reliability in the diagnosis of femoral trochanteric fractures; with the addition of 3D-CT, it will increase.…”

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confidence: 99%

“…The current version, revised in 2018, has provided acceptable reliability in the diagnosis of femoral trochanteric fractures; with the addition of 3D-CT, it will increase. If we do not have 3D tomography equipment in our hospital, the current AO/OTA classification of intertrochanteric fractures should be used in some way, using the three main types, because this allows a common language among treating physicians [18][19][20].…”

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confidence: 99%

Proximal Femur Fracture: Common Doubts on Frequently Used Terminologies

Edgar

2023

Series Clin Med Case Rep Rev

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Avaliação das concordâncias intra e interobservadores da nova classificação AO/OTA para fraturas da região trocantérica e do colo do fêmur

Cited by 3 publications

References 27 publications

Intertrochanteric (Reverse Oblique) Fracture Subclassifications AO/OTA 31-A3 Have No Effect on Outcomes or Postoperative Complications

Intertrochanteric (Reverse Oblique) Fracture Subclassifications AO/OTA 31-A3 Have No Effect on Outcomes or Postoperative Complications

Does the OTA Open Fracture Classification Align With the Gustilo-Anderson Classification? A Study of 2215 Open Fractures

Proximal Femur Fracture: Common Doubts on Frequently Used Terminologies

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