Cem Yıldırım1, Osman Görkem Muratoğlu2, Kaya Turan2, Tugrul Ergün3, Abdulhamit Mısır4, Mahmud Aydın5

1Department of Orthopedics and Traumatology, Cam and Sakura City Hospital, Istanbul, Turkey
2Department of Orthopedics and Traumatology, Istinye University, Istanbul, Turkey
3Department of Orthopedics and Traumatology, Bahçeşehir Liv Hospital, Istanbul, Turkey
4Department of Orthopedics and Traumatology, Medicana International Hospital, Istanbul, Turkey
5Department of Orthopedics and Traumatology, Haseki Training and Research Hospital, Istanbul, Turkey

Keywords: Classification, fracture, interobserver, intertrochanteric, intraobserver.


Objectives: This study aims to evaluate the effect of surgical experience on reliability for Boyd-Griffin, Evans/Jensen, Evans, Orthopaedic Trauma Association (main and subgroups), and Tronzo classification systems.

Patients and methods: Between January 2013 and December 2014, radiological images of a total of 60 patients (13 males, 47 females; mean age: 78.9±21.9 years; range, 61 to 96 years) with the diagnosis of intertrochanteric femur fracture were analyzed. Radiographs were evaluated and classified by five residents and five orthopedics and traumatology surgeons according to the Evans, Boyd-Griffin, Evans/Jensen, OTA, and Tronzo classification systems. Intraand interobserver reliability were calculated using the kappa statistics.

Results: The worst intraobserver compatibility among the residents was the classification system with OTA subgroups (κ=0.516), while the classification system with the best intraobserver fit was found to be OTA main groups (κ=0.744). The worst agreement among surgeons was in the Evans classification system (κ=0.456). However, the best intraobserver agreement was in the OTA main groups (κ=0.741). The best interobserver agreement was observed regarding the OTA main groups (κ=0.699).

Conclusion: The classification that has the best harmony both among residents and surgeons, and between residents and surgeons is the OTA main group classification.

Citation: Yıldırım C, Muratoğlu OG, Turan K, Ergün T, Mısır A, Aydın M. The intra- and interobserver reliability of five commonly used intertrochanteric femur fracture classification systems. Jt Dis Relat Surg 2022;33(1):187-192.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.