FEMORAL NECK FRACTURES AND CLASSIFICATIONS RELIABILITY: ARE WE USING REPRODUCIBLE SYSTEMS?

Introduction: Classification systems for femoral neck fractures are very helpful for surgeons in order to choose the correct treatment. The purpose of this study was to verify the reliability and reproducibility in the most used classifications for proximal medial femoral fracture: Garden and Pauwels classifications. Materials and methods: Five surgeons independently classified 82 intra-capsular femur fractures treated with 3 cannulated screws using Pauwels and Garden classifications measured on pre- and post-operatively X-Rays. Inter-observer agreement was calculated for both classifications using the multi-rater Fleiss’ kappa; intra-observer agreement from pre-operative to post-operative XRs for Pauwels classification was also calculated with the same method. Results: Only six cases of AVN were registered. The inter-observers agreement based on pre-operative X-rays was moderate for Pauwels classification ([Formula: see text] 0.528) and slightly lower for Garden classification ([Formula: see text] 0.448); but in the simplified Garden classification (type I and II not displaced vs type III and IV displaced) the agreement measured was almost perfect ([Formula: see text] 0.908). The intra-observer agreement for Pauwels classification was moderate ([Formula: see text] 0.456). All the results were statistically significant. Conclusions: This is the first study evaluating the Pauwels angle on both preoperative and postoperative X-rays to assess their reproducibility. Garden classification has a really high reliability and reproducibility in evaluating displaced and not displaced fractures and consequently can be helpful in choosing the correct treatment. Pauwels classification has a lower inter and intra-observer agreement.

Results of the Experimental Research and Clinical Application of Cannulated Screw with Bioactive Coverage on the Basis of Natural Hydroxiapatite during Osteosynthesis of Medial Fractures of Femur’s Neck

The goal of our research is clinical-experimental justification of differentiated application of osteosynthesis methodicsand application of cannulated screw with bioactive coverage on the basis of natural hydroxiapatitefor patients of old and senile age with the medial fracture of femur’s neck (MFFN) with taking into account the stability grade of fracture by Pauwels classification and motional activity of patients before trauma. The present research is based upon clinical observation of 110 old and senile patients with supcapital and transcervical femur’s neck fractures. With the purpose of scientific justification and detailed research of different types of MFFN osteosynthses experimental stand tests were conducted with the use of cannulated screws and methodic of vertical ostesynthesis by H. Kuntscher for determining and comparison of density and strength of experimental systems “fixator-bone” in static regime over MFFN models. Cannulated screws with bioactive coverage on the basis of natural hydroxyapatite were applied for 16 patients among all operated by us. Time of rehabilitation of supporting and motional functions of the limb has been decreased by using these implants among patients with grades I and II (by Pauwels classification). Thanks to osteoinductive and osteoconductive features of bioactive coverage on the basis of natural hydroxyapatite, rehabilitation of operated limb’s function was conducted in shorter terms and faster rate. For the purpose of obtaining the dynamic stability of osteosynthesis and conduction of accelerated rehabilitation cannulated cervical screw was developed and applied in practice. This screw is different in the design of spiral part and the presence on its surface of bioactive coverage on the basis of natural hydroxyapatite.