Philipp Pieroh1,2,3, Andreas Höch1,3, Tim Hohmann2, Florian Gras3,4, Sven Märdian3,5, Alexander Pflug4, Silvan Wittenberg5, Christoph Ihle6, Notker Blankenburg1, Kevin Dallacker-Losensky7, Tanja Schröder8, Steven C Herath3,8, Daniel Wagner3,9, Hans-Georg Palm3,7, Christoph Josten1,3, Fabian M Stuby3,6. 1. Department of Orthopedics, Trauma, and Plastic Surgery, University of Leipzig, Leipzig, Germany. 2. Department of Anatomy and Cell Biology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany. 3. German Pelvic Injury Register of the German Society of Traumatology (Deutsche Gesellschaft für Unfallchirurgie [DGU]) and the German Section of the AO Foundation, Berlin, Germany. 4. Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Jena, Jena, Germany. 5. Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Berlin, Germany. 6. BG Trauma Center, Eberhard Karls University, Tübingen, Germany. 7. Trauma Research Group, Department of Trauma Surgery and Orthopedics, Reconstructive and Septic Surgery, and Sports Traumatology, German Armed Forces Hospital of Ulm, Ulm, Germany. 8. Department of Trauma, Hand and Reconstructive Surgery, Saarland University Hospital, Homburg, Germany. 9. Department of Orthopedics and Traumatology, University Medical Center Mainz, Mainz, Germany.
Abstract
BACKGROUND: The fragility fractures of the pelvis (FFP) classification was established to address the specific fracture morphology and dynamic instability in the elderly. Although this system is frequently used, data on the intra-rater and inter-rater reliabilities are lacking. METHODS: Six experienced and 6 inexperienced surgeons and 1 surgeon trained by the originator of the FFP classification ("gold standard") each used the FFP classification 3 times to grade the computed tomography (CT) scans of 60 patients from 6 hospitals. We assessed intra-rater and inter-rater reliabilities using Fleiss kappa statistics and the percentage of agreement using the "gold standard," the submitting hospital, and the majority vote as references. RESULTS: The intra-rater reliability for the FFP classification was mainly moderate, with a mean Fleiss kappa coefficient (and 95% confidence interval) of 0.46 (0.40 to 0.50) for the complete classification (i.e., both the main-group FFP ratings [I through III] and the subgroup ratings [a, b, and c]) and 0.60 (0.53 to 0.65) for the main group only. The inter-rater reliability was substantial for the main group classification (0.61 [0.54 to 0.66]) and moderate for the complete classification (0.53 [0.48 to 0.58]). The percentage of agreement was 68% to 80%. The lowest agreement was found for FFP II and III. CONCLUSIONS: The FFP classification displayed moderate and substantial intra-rater and inter-rater reliabilities. CLINICAL RELEVANCE: With moderate to substantial intra-rater and inter-rater reliabilities, the FFP classification forms a solid basis for future clinical investigations. The differentiation of FFP II from FFP III should be evaluated thoroughly, as the initial treatment changes from nonoperative for II to operative for III.
BACKGROUND: The fragility fractures of the pelvis (FFP) classification was established to address the specific fracture morphology and dynamic instability in the elderly. Although this system is frequently used, data on the intra-rater and inter-rater reliabilities are lacking. METHODS: Six experienced and 6 inexperienced surgeons and 1 surgeon trained by the originator of the FFP classification ("gold standard") each used the FFP classification 3 times to grade the computed tomography (CT) scans of 60 patients from 6 hospitals. We assessed intra-rater and inter-rater reliabilities using Fleiss kappa statistics and the percentage of agreement using the "gold standard," the submitting hospital, and the majority vote as references. RESULTS: The intra-rater reliability for the FFP classification was mainly moderate, with a mean Fleiss kappa coefficient (and 95% confidence interval) of 0.46 (0.40 to 0.50) for the complete classification (i.e., both the main-group FFP ratings [I through III] and the subgroup ratings [a, b, and c]) and 0.60 (0.53 to 0.65) for the main group only. The inter-rater reliability was substantial for the main group classification (0.61 [0.54 to 0.66]) and moderate for the complete classification (0.53 [0.48 to 0.58]). The percentage of agreement was 68% to 80%. The lowest agreement was found for FFP II and III. CONCLUSIONS: The FFP classification displayed moderate and substantial intra-rater and inter-rater reliabilities. CLINICAL RELEVANCE: With moderate to substantial intra-rater and inter-rater reliabilities, the FFP classification forms a solid basis for future clinical investigations. The differentiation of FFP II from FFP III should be evaluated thoroughly, as the initial treatment changes from nonoperative for II to operative for III.
Authors: Daniel Wagner; Andreas Höch; Philipp Pieroh; Tim Hohmann; Florian Gras; Sven Märdian; Alexander Pflug; Silvan Wittenberg; Christoph Ihle; Notker Blankenburg; Kevin Dallacker-Losensky; Tanja Schröder; Steven C Herath; Hans-Georg Palm; Christoph Josten; Fabian M Stuby Journal: Sci Rep Date: 2022-02-11 Impact factor: 4.379
Authors: Pol Maria Rommens; Johannes Christoph Hopf; Charlotte Arand; Kristin Handrich; Mehdi Boudissa; Daniel Wagner Journal: Eur J Trauma Emerg Surg Date: 2022-02-05 Impact factor: 2.374