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ABSTRACT
Letournal and Judet classification of acetabular fracture
is widely used. The classification is based on the
identification of fracture lines on plain radiographs.
Three-dimensional CT scan was claimed to give a
better view of the fracture line.
Our study showed that intraobserver
reproducibility and interobserver reliability were
almost the same when classification was done by using
plain radiographs and 3D-CT scan. And 3D-CT scan
did not increase either the interobserver reliability or
the intraobserver reproducibility in classifying the
fracture.
Key words: Letournal and Judet classification, acetabular
fracture, three dimensional CT scan, intraobserver
reproducibility, interobserver reliability
INTRODUCTION
Letournel and Judet classification (L-J classification)5,10
of the acetabular fracture is widely used (Fig. 1). Plain
Address correspondence and reprint requests to: Dr Boonyarak Visutipol, Lerdsin General Hospital, Silom Road, Bangkok, 10500
Thailand.
34
Figure 1
Figure 2
2D-CT scan
35
RESULTS
Figure 3
views.
MATERIALS
AND
METHODS
K plain radiograph
K 3D-CT scan
0.33
0.47
0.59
0.38
0.24
0.46
0.56
0.59
0.39
0.30
Table 2
Interobserver reliability
Kappa coefficients for interobserver reliability
Plain radiography
3D-CT scan
36
DISCUSSION
Plain radiography in AP and both oblique views of
the pelvis, as described by Judet et al.,8 has long served
as the standard for diagnosis of acetabular fractures.
Modern computerized scan in 2 dimensions has been
suggested to be superior in the detection of fracture
involving the sacrum, quadrilateral surface, acetabular
roof, posterior acetabular lip and the abnormality of
the joint space.6,12 The disadvantage is that many
images have to be viewed. 3D-CT scan, which can be
rotated in different views and some parts can be erased
for a better vision, was claimed to be more useful in
characterizing complex displacement of the
acetabulum.1,2
Our study was not designed to evaluate the
efficacy of the 3D-CT scan in identifying the fracture
lines. The objective of our study was to evaluate the
level of agreement of one observer and among different
observers in classifying acetabular fracture using L-J
classification.
From our study, moderate intraobserver
reproducibility (K = 0.42) and fair interobserver
reliability (K = 0.24) were observed when the
classification was done using plain radiographs. When
the classification was done using 3D-CT scan, the
intraobserver reproducibility increased slightly but
remained in the moderate level of agreement (K = 0.42)
while the interobserver reliability remained the same
(K = 0.24). We think the reasons why both the
intraobserver reproducibility and interobserver
reliability were low in L-J classification is because the
classification is too complicated (there are 10 types)
and too difficult to differentiate one type from the other
especially in complex fracture groups. Though 3D-CT
CONCLUSION
Intraobserver reproducibility and interobserver
reliability were found to be low in L-J classification
and 3D-CT scan did not seem to increase them. The
results of this study suggest that Letournel and Judet
classification might be too complicated and too difficult
for the average orthopaedic surgeon.
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