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Sagittal deformity of Garden type I and II geriatric femoral neck fractures is frequently misclassified by lateral radiographs. Journal Article
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| Authors: | Tiee, MS; Golz, AG; Kim, A; Cohen, JB; Summers, HD; Alexander, AJ; Lack, WD |
| Article Title: | Sagittal deformity of Garden type I and II geriatric femoral neck fractures is frequently misclassified by lateral radiographs. |
| Abstract: | UNLABELLED: The objective of this study was to determine the validity and inter-rater reliability of radiographic assessment of sagittal deformity of femoral neck fractures. DESIGN: This is a retrospective cohort study. SETTING: Level 1 trauma center. PATIENTS/PARTICIPANTS: Thirty-one patients 65 years or older who sustained low-energy, Garden type I/II femoral neck fractures imaged with biplanar radiographs and either computed tomography or magnetic resonance imaging were included. MAIN OUTCOME MEASUREMENTS: Preoperative sagittal tilt was measured on lateral radiographs and compared with the tilt identified on advanced imaging. Fractures were defined as "high-risk" if posterior tilt was =20 degrees or anterior tilt was >10 degrees. RESULTS: Of 31 Garden type I/II femoral neck fractures, advanced imaging identified 10 high-risk fractures including 8 (25.8%) with posterior tilt =20 degrees and 2 (6.5%) with anterior tilt >10 degrees. Overall, there was no significant difference between sagittal tilt measured using lateral radiographs and advanced imaging ( = 0.84), and the 3 raters had good agreement between their measurements of sagittal tilt on lateral radiographs (interclass correlation coefficient 0.79, 95% confidence interval [0.65, 0.88], 0.01). However, for high-risk fractures, radiographic measurements from lateral radiographs alone resulted in greater variability and underestimation of tilt by 5.2 degrees (95% confidence interval [-18.68, 8.28]) when compared with computed tomography/magnetic resonance imaging. Owing to this underestimation of sagittal tilt, the raters misclassified high-risk fractures as "low-risk" in most cases (averaging 6.3 of 10, 63%, range 6 - 7) when using lateral radiographs while low-risk fractures were rarely misclassified as high-risk (averaging 1.7 of 21, 7.9%, range 1 - 3, = 0.01). CONCLUSIONS: Lateral radiographs frequently lead surgeons to misclassify high-risk sagittal tilt of low-energy femoral neck fractures as low-risk. Further research is necessary to improve the assessment of sagittal plane deformity for these injuries. LEVEL OF EVIDENCE: Level IV diagnostic study. |
| Journal Title: | OTA international : the open access journal of orthopaedic trauma |
| Publisher: | Unknown |
| Date Published: | 2023 |
