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Reliability of the AO group and Garden’s classification system of femoral neck fractures in the assessment of fracture with or without displacements

Aim: To determine the degree of clinical reliability and repeatability of the classification systems for neck femoral fractures according to the AO group and Garden estimate of fracture on the fractures with or without displacement according to the coefficient kappa value indispensable in the choice of treatment methods. Methods: Five observers classified 70 randomly selected anterior-posterior (AP) and lateral view preoperative radiographs of femoral neck fractures according to the AO group and Garden's classification systems. The procedure was repeated on the same radiographs after three months. The first classification was used to calculate the inter observer agreement by kappa value between observers, while the first and second classification served to calculate the kappa value for each examiner. Then we set fractures without displacement by AO group B1 and by Garden I+II and fractures with displacement to the AO group B2 + B3 and Garden III+IV. With the same statistical method we have determined the kappa coefficient value for inter observer and intra observer agreement for such as a reduced form classification system of femoral neck fractures. Results: The overall mean value for the classification system for inter observer agreement is: AO К = 0.48, Garden К = 0.42 Mean intra observer agreement for AO group К = 0.55, Garden К = 0.50 coefficient kappa value. The overall mean for reduced form classification system for inter observer agreement is: reduced form of AO К = 0.69, reduced form of Garden К = 0.57 Mean intra observer agreement for reduced form AO group К = 0.68, reduced form Garden 0.74 coefficient kappa value (К) (p < 0.05). Conclusion: The Garden and AO group are the only ones useful for the division of femoral neck fractures without displacement and with displacement. To determine the methods of femoral neck fracture treatment, a reduced form of Garden´s classification system or reduced form of AO group is more reliable than the Garden or AO group classification system.

femoral neck fractures ; AO group classification system for femoral neck fractures ; Garden's classification system ; kappa statistics ; predict of treatment

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