Complication reporting and assessment is an important part of orthopaedic trials assessing new technologies. Because the reliability of the assessment by the treating surgeon compared to central review is still unknown, it was quantified in this study and possible patterns were identified. 176 patients with trochanteric fractures, treated with a trochanteric nail, were included in a prospective multicenter study. Surgeons were encouraged to report honestly every single potential complication, to rate severity, most likely cause, relation to implant, and to report the outcome of the complication. After 1-yr follow-up, 3 experienced orthopedic surgeons reassessed independently the same variables (agreement determined using kappa coefficient). Discrepancies were resolved by consensus.Introduction
Materials and methods
Proxy assessment of health-related quality of life (HRQoL) can be an alternative to self reporting in elderly patients with cognitive or physical impairment. However, over- and underestimation by the proxies is reported. The aim of the present study was to examine the agreement of HRQoL answers between old Japanese patients and their close relatives. In a clinical study about trochanteric fractures, HRQoL was assessed using the SF36v2. A sample of 27 questionnaires were completed via telephone interview twice on the same day: once by the patients themselves, and once by a close relative. Assessments were performed at either 6 or 12 mo after surgery. The reliability of the SF36v2 dimensions and of the 2 component summary measures was assessed by Intraclass Correlation Coefficients.Introduction
Materials and methods
When translating the principle of intramedullary nailing for trochanteric femoral fractures to Asian patients, design modifications made to adjust for anatomic differences resulted in an PFNA Asia. The primary endpoint of this study was the rate of complications attributable to fracture fixation. A prospective multicenter case series was performed; 176 patients with a median age of 84 with unstable trochanteric fractures treated with a PFNA Asia were included and followed for one year postoperatively. Complications were reviewed by a complication review board (CRB). Intra- and postoperative fracture fixation complications are presented according to type and incidence proportions (risk).Introduction
Material and methods
Tip apex distance (TAD) is reported as a predictor for cut outs of lag screws in the treatment of intertrochanteric fractures, and surgeons are adviced to strive for TAD within 20 mm. However the definition of neck axis and the limb position of lateral radiograph are not clearly described in the original literature. We propose the refined TAD by defining these factors. The objective of this study was to analyze the interobserver agreement of this refined TAD. X rays of 130 cases of unstable trochanteric fractures were used for the analysis of the refined TAD. In the refined TAD, neck axis was defined as the line between the center of femoral head and midpoint of narrowest part of the femoral neck, and lateral radiograph was taken with hip flexion 90 degrees and abduction 45 degrees. The refined TAD was independently measured by 2 experienced (observer 1,2) and 2 inexperienced (observer 3,4) orthopaedic surgeons who were trained with the new method before the measurement. Intraclass correlation coefficient (ICC [2,4]) was calculated to assess the interobserver agreement.Introduction
Materials and Method
For the increasing number of frail elderly patients in Japan, mobility is crucial to stay independent and maintain quality of life. After failure reports with standard implants, a prospective multicentre study was performed to evaluate whether an implant designed for Asians enables rapid recovery after unstable trochanteric fractures. Patients with an AO 31A2 or A3 fracture sustained less than 7 days before fracture fixation with the Asian version of the Proximal Femoral Nail Antirotation. Those with severe dementia and bedridden or confined to a wheelchair were excluded. Outcome parameters were quality of life (SF36v2, EQ5D), mobility (Parker Mobility score PMS) and range of motion (ROM).Introduction
Materials and methods
