J Med Assoc Thai 2017; 100 (11):1210

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Original ArticleOpen Access
Reliability of Diagnosis of Acetabular Fracture from Radiographic Films Using Systematic Guidelines: A Sawbones Study
Plumarom Y Mail, Purksamatanun P , Phruetthiphat O , Sawatdeepong A , Chanpradap W

Background: The treatment of injuries involving the acetabulum is challenging. A surgeon has to decide whether surgical intervention is indicated, and choose the ideal surgical approach. According to Letournel-Judet, each acetabular fracture pattern is approached by a unique, individual approach. The correct classification of the injury pattern is based on the observation of radiography using anteroposterior and two oblique views. However, the ideal radiographic examination, which helps identify the correct classification could still be problematic. The systematic evaluation is initially based on the integrity of the iliopectineal and/or ilioischial line, called ‘‘basic lines’’.

Objective: To investigate whether the implementation of a radiographic algorithmic method could increase the reliability and validity of the Letournel classification system among orthopedic surgeons.

Material and Method: All of the fractured-saw bones were sent to take radiographs. The radiographies of all ten types of Letournel-Judet classification were randomly selected in order to be evaluated by 20 orthopedic residents and fellows. Each of them made a diagnosis of five types of radiographs, which had been already randomized. Therefore, there were 100 randomized radiographs that were evaluated. There are two methods used as guidelines in the present study. First, every observer studied with no instructions or guidelines. Second, the observers had to examine the same set of radiographs by taking into account a guideline algorithm protocol. Last, the agreement of the observers, related to the bone models was estimated. The unweighted kappa coefficient was utilized to estimate the observers’ agreement arising from the examination of the given X-rays.

Results: The main finding in the present study lied on improvement of the agreement, in the second group over the first. The total agreement rate was increased from 61.0% in the first group to 81.0% in the second group after using the systematic guidelines, (p-value <0.001).

Conclusion: Findings from the present study confirmed the reliability of Letournel classification system and the systematic guideline algorithm protocol further improved the ability to classify the acetabular fractures types.

Keyword: Acetabulum, Letournel-Judet classification, Iliopectineal line, Ilioischial line, Proposed guidelines, Reliability


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