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OBJECTIVE: The objective of the present study was to identify patterns of femoral diaphyseal fractures which are associated with fractures of the ipsilateral femoral neck according to the AO classification. We propose an algorithm of investigation based on plain radiographs, recognizing cases that need additional screening with computed tomography. PATIENTS AND METHODS: This observational retrospective study included patients with combined diaphyseal and femoral neck fractures. These patients were retrieved from a total of 1398 patients with the diagnoses of diaphyseal fractures of the femur, who were admitted to our hospital for surgical treatment between January 2009 and October 2019. All included cases had both fractures analyzed for their geometry and were classified according to the AO Classification, seeking to find a correlation between the types of fractures. RESULTS: Sixteen diaphyseal fractures associated with ipsilateral neck fractures were detected during the period. The distribution of the diaphyseal fractures according to the AO Classification was as follows: 5 of type A3 (31,2%) 6 type B2 (37.5%), 1 type B3 (6,2%), 2 type C2 (12,5%) and 2 type C3 (12,5%). One A2 femoral fracture occurred during the surgical procedure. No type A1 fractures were detected. CONCLUSION: The patterns of high-energy diaphyseal fractures (A3, B and C) have a higher prevalence of associated ipsilateral neck fractures. Our study suggests that routine additional methods of image investigation of femoral neck fractures may be unnecessary for diaphyseal fractures type A1 and A2.

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ABSTRACT Objective: To evaluate the inter and intraobserver agreement of the Magerl AO and AOSpine thoracolumbar fracture classification systems. Methods: The participants were divided into two groups, the first composed of six spinal surgeons and the other composed of 18 medical orthopedic residents. On two different occasions, separated by an interval of one month, the participants analyzed and classified 25 radiographs with thoracolumbar fractures using both thoracolumbar fracture classification systems, Magerl AO and AOSpine. The results were analyzed for classification reliability using the Kappa coefficient (k). Results: The Magerl AO classification system showed a fair interobserver agreement (k = 0.32), considering the fractures type and subtype, whereas the AOSpine classification system showed a moderate interobserver agreement (k = 0.59). The Magerl AO classification showed a fair intraobserver agreement for both residents and specialists (k = 0.21 and 0.38, respectively), while the AOSpine showed a substantial agreement between residents (k = 0.62) and moderate between specialists (k = 0.53). Conclusions: When evaluating fracture morphology, the AOSpine thoracolumbar fracture classification system presented a better reliability and reproducibility compared to the Magerl AO classification system.

RESUMO Objetivo: Avaliar a concordância inter e intraobservadores dos sistemas de classificação Magerl AO e AOSpine para fraturas toracolombares. Métodos: Os participantes foram divididos em dois grupos, um com seis médicos ortopedistas especialistas em coluna e o outro com 18 médicos residentes em ortopedia. Os participantes analisaram 25 radiografias com fraturas toracolombares em duas oportunidades, com um mês de intervalo entre elas, e classificaram com o uso dos dois sistemas de classificação de fratura toracolombar, Magerl AO e AOSpine. Os dados de concordância foram analisados pelo método do coeficiente kappa. Resultados: A classificação de Magerl AO apresentou uma concordância interobservadores leve (k = 0,32), considerando o tipo e o subtipo das fraturas, enquanto a classificação AOSpine obteve uma concordância interobservadores moderada (k = 0,59). A classificação de Magerl AO apresentou uma concordância intraobservadores leve entre médicos residentes e médicos especialistas (k = 0,21 e 0,38, respectivamente), enquanto a classificação AOSpine apresentou uma boa concordância intraobservadores entre médicos residentes (k = 0,62) e moderada entre médicos especialistas (k = 0,53). Conclusão: O sistema de classificação da AOSpine para fraturas toracolombares apresentou uma melhor confiabilidade e reprodutibilidade comparado com o sistema de classificação Magerl AO, em relação à morfologia da fratura.

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OBJECTIVE: To evaluate the inter and intraobserver agreement of the Magerl AO and AOSpine thoracolumbar fracture classification systems. METHODS: The participants were divided into two groups, the first composed of six spinal surgeons and the other composed of 18 medical orthopedic residents. On two different occasions, separated by an interval of one month, the participants analyzed and classified 25 radiographs with thoracolumbar fractures using both thoracolumbar fracture classification systems, Magerl AO and AOSpine. The results were analyzed for classification reliability using the Kappa coefficient (k). RESULTS: The Magerl AO classification system showed a fair interobserver agreement (k = 0.32), considering the fractures type and subtype, whereas the AOSpine classification system showed a moderate interobserver agreement (k = 0.59). The Magerl AO classification showed a fair intraobserver agreement for both residents and specialists (k = 0.21 and 0.38, respectively), while the AOSpine showed a substantial agreement between residents (k = 0.62) and moderate between specialists (k = 0.53). CONCLUSIONS: When evaluating fracture morphology, the AOSpine thoracolumbar fracture classification system presented a better reliability and reproducibility compared to the Magerl AO classification system.

OBJETIVO: Avaliar a concordância inter e intraobservadores dos sistemas de classificação Magerl AO e AOSpine para fraturas toracolombares. MÉTODOS: Os participantes foram divididos em dois grupos, um com seis médicos ortopedistas especialistas em coluna e o outro com 18 médicos residentes em ortopedia. Os participantes analisaram 25 radiografias com fraturas toracolombares em duas oportunidades, com um mês de intervalo entre elas, e classificaram com o uso dos dois sistemas de classificação de fratura toracolombar, Magerl AO e AOSpine. Os dados de concordância foram analisados pelo método do coeficiente kappa. RESULTADOS: A classificação de Magerl AO apresentou uma concordância interobservadores leve (k = 0,32), considerando o tipo e o subtipo das fraturas, enquanto a classificação AOSpine obteve uma concordância interobservadores moderada (k = 0,59). A classificação de Magerl AO apresentou uma concordância intraobservadores leve entre médicos residentes e médicos especialistas (k = 0,21 e 0,38, respectivamente), enquanto a classificação AOSpine apresentou uma boa concordância intraobservadores entre médicos residentes (k = 0,62) e moderada entre médicos especialistas (k = 0,53). CONCLUSÃO: O sistema de classificação da AOSpine para fraturas toracolombares apresentou uma melhor confiabilidade e reprodutibilidade comparado com o sistema de classificação Magerl AO, em relação à morfologia da fratura.

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OBJECTIVE: The purposes of this study were to describe the CT features of isolated posterior acetabular wall fractures with associated marginal impaction and to discuss the potential therapeutic implications of recognizing this type of fracture. CONCLUSION: Marginal impaction is an important cause of articular incongruity that adversely affects prognosis. Radiologists should be capable of identifying posterior acetabular wall fracture patterns because they may be the first to suggest diagnoses.

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BACKGROUND: Although classification systems of olecranon fractures are important to help choose the best treatment and to predict prognosis, their degree of observer agreement is poorly investigated. The objective of this study was to investigate the intraobserver and interobserver reliability of currently used classification systems for olecranon fractures. Our hypothesis is that the Colton classification presents an acceptable agreement because it is simpler to use; on the other hand, considering the AO classification's complexity, we expect it to reach a lower level of agreement. METHODS: Radiographic images of elbow joint fractures were classified according to Colton, AO, Mayo, and Schatzker classification systems. The raters were 8 orthopedic surgeons split into 2 groups with 4 participants each, one with specialists in upper extremity surgery and the other with orthopedic surgeons without a specific focus on upper extremity surgery. This first procedure was the pretest training, aimed at calibrating participants' judgment. Image classification was conducted after all training was completed. After 30 days from the initial rating session, the test was conducted once again following the exact same procedures. RESULTS: The Colton classification has substantial intraobserver and interobserver agreement for specialists and nonspecialists. The Schatzker classification revealed a fair agreement for both specialists and nonspecialists. A fair concordance was also found for the Mayo classification. The AO classification demonstrated a moderate rate of agreement for specialists, whereas nonspecialists presented slight intraobserver agreement. CONCLUSION: No classification system is widely accepted because it can be affected by interobserver variability, which can raise questions about its use in a research as well as in a clinical context.

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