Radiographies under Traction Influence Surgeon Choice in Implant Selection for Intertrochanteric Fractures
|Robinson E.S Pires*1,3, Bruno G. S. Souza2, Marcos. L. Leite3, Ricardo H. Miranda4, Marcos T. C. Lopes4, Carlos F. T. Barros4, César R. C. Fontenelle5, Hélio J. A. Fernandes6, Fernando B. Reis6 and Marco A. P. Andrade1|
|1Department of Orthopaedics and Traumatology at Federal University of Minas Gerais. Belo Horizonte (MG), Brazil.|
|2Department of Orthopaedics and Traumatology, Hospital de Misericórdia, Santos Dumont (MG), Brazil.|
|3Department of Orthopaedics and Traumatology, Felício Rocho Hospital, Belo Horizonte (MG), Brazil.|
|4Department of Orthopaedics and Traumatology, Santa Casa Hospital, Belo Horizonte (MG), Brazil.|
|5Department of Orthopaedics and Traumatology, Federal University of Rio de Janeiro, Rio de Janeiro (RJ), Brazil.|
|6Department of Orthopaedics and Traumatology, Federal University of São Paulo (SP), Brazil.|
|Corresponding Author :||Robinson Esteves Santos Pires
Department of Orthopaedics and Traumatology
Felício Rocho Hospital, Avenida do Contorno 9530
Barro Preto, Belo Horizonte (MG), CEP:30110-934, Brazil
E-mail: [email protected]
|Received March 05, 2012; Accepted April 20, 2012; Published April 23, 2012|
|Citation: Pires RES, Souza BGS, Leite ML, Miranda RH, Lopes MTC, et al. (2012) Radiographies under Traction Influence Surgeon Choice in Implant Selection for Intertrochanteric Fractures. J Trauma Treat 1:131. doi:10.4172/2167-1222.1000131|
|Copyright: © 2012 Pires RES, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.|
Objective: Determine whether preoperative AP pelvis radiographies under manual traction influence surgeon choice for implants in intertrochanteric fractures compared with standard radiographies.
Methods: Fifty-eight patients with intertrochanteric fractures were prospectively enrolled from four tertiary teaching hospitals. All patients had standard AP pelvis radiographies taken as well as radiographies under manual traction of affected limb, 116 images total. Three fellowship trained trauma surgeons and three hip surgeons blindly reviewed the images and indicated their implant choice for each case: extra or intramedullary fixation. The observers received randomly assigned images and were unaware of the radiography technique, patient number, and repetition of patients within the set of images. Statistical analyses were performed using Cohen Kappa method and McNemar, Q Cochran, and Wilcoxon tests.
Results: Manual traction radiographies changed surgeon-implant choice in 35.06% (range: 27.6% to 43.1%). However, traction radiographies provided no improvement in weak inter-observer reliability for treatment indication (k=0.264, p<0.001) compared to standard radiographies (k=0.220, p<0.001), when using Mann-Whitney test (p=0.359). Traction views did not increase predilection for either method. Hip surgeons agreed more than trauma surgeons concerning implant choice.
Conclusions: Manual traction radiographies modified surgeon choice in up to one third of intertrochanteric fracture cases.