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首页> 外文期刊>Canadian journal of surgery: Journal canadien de chirurgie >Subcapital hip fractures: the Garden classification should be replaced, not collapsed.
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Subcapital hip fractures: the Garden classification should be replaced, not collapsed.

机译：首都圈下髋部骨折：应按花园分类，而不是塌陷。

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OBJECTIVES: To evaluate rater agreement for a simple 2-category classification of subcapital hip fractures versus the 4-category Garden classification and to determine the effect of clinician experience on the level of agreement. SETTING: Sunnybrook and Women's Health Sciences Centre, Toronto, a level 1 trauma centre. METHOD: Eleven raters, with varying levels of clinical experience (3 fellowship-trained orthopedic surgeons, 4 clinical fellows and 4 residents), classified 34 pairs of anteroposterior and lateral radiographs of patients with subcapital hip fractures according to whether the fracture was stable (the fragments move as a unit) or unstable (the fragments move independently), and according to Garden's original 4-category classification. The exercise was repeated 1 month later. The radiographs were obtained from a fracture database to represent a wide spectrum of injury severity. OUTCOME MEASURES: The level of agreement beyond chance, quantified by use of the SAV statistic of O'Connell and Dobson. RESULTS: The most experienced raters demonstrated almost perfect inter- and intrarater agreement with respect to stable and unstable fractures (SAV > 0.80). The raters demonstrated only fair agreement for the Garden classification (mean SAV 0.64). Even junior clinicians demonstrated substantial agreement regarding fracture stability, with much lower scores for the Garden classification. Collapsing the Garden classification responses into 2 categories (stages I and II v. III and IV) was not synonymous with rater categorization of stable versus unstable. CONCLUSION: The Garden classification for subcapital hip fractures is unreliable and should be abandoned in favour of categorizing fractures as stable versus unstable.
机译：目的：评估简单的2类资本下髋骨骨折与4类Garden分类的评估者一致性，并确定临床医生经验对一致性水平的影响。地点：多伦多桑尼布鲁克妇女健康科学中心，这是一处创伤中心。方法：11名评估者，具有不同的临床经验水平（3名接受过研究金培训的骨科医师，4名临床研究员和4名住院医师）根据骨折是否稳定，对34例首都圈下髋部骨折患者的前后位和侧位X线照片进行了分类（碎片会整体移动）或不稳定（碎片会独立移动），并且按照Garden最初的4类分类。 1个月后重复该练习。 X射线照片是从骨折数据库获得的，代表了各种损伤严重程度。观察指标：通过使用O'Connell和Dobson的SAV统计数据来量化超出偶然性的一致程度。结果：经验最丰富的评估者对稳定和不稳定骨折表现出几乎完美的评估者内部和评估者一致性（SAV> 0.80）。评分者仅对花园分类显示公平的协议（平均SAV为0.64）。即使是初级临床医生也对骨折的稳定性表现出了实质性的共识，但Garden分类的评分要低得多。将“花园”分类反应分为两类（第一阶段和第二阶段，第三阶段和第四阶段）与稳定对不稳定的评估者分类不是同义的。结论：首都圈下髋部骨折的Garden分类是不可靠的，应放弃以将骨折分为稳定与不稳定分类。

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