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Functional Classification of Joints01:09

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Functional Classification of Joints
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Updated: Dec 13, 2025

Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
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New Classification and Its Value Evaluation for Atlantoaxial Dislocation.

Tan Mingsheng1, Gong Long1, Yi Ping1

  • 1Department of Orthopedics, China-Japan Friendship Hospital, Peking Union Medical College, Chinese Academy of Medical College, Beijing, 100029, China.

Orthopaedic Surgery
|July 26, 2020
PubMed
Summary
This summary is machine-generated.

The TOI classification system for atlantoaxial dislocation (AAD) shows moderate to substantial reliability for both classification and treatment choice. This system aids surgeons, even less experienced ones, in selecting appropriate treatment strategies for AAD.

Keywords:
Atlantoaxial dislocationClassificationReliability test

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Area of Science:

  • Orthopedic Surgery
  • Spine Surgery
  • Radiology

Background:

  • Atlantoaxial dislocation (AAD) presents diagnostic and therapeutic challenges.
  • A standardized classification system is needed to guide treatment decisions for AAD.
  • The TOI (Traction reduction type, Operation reduction type, Irreducible type) classification system is proposed.

Purpose of the Study:

  • To introduce the TOI classification system for atlantoaxial dislocation (AAD).
  • To evaluate the interobserver and intraobserver reliability of the TOI classification system.
  • To assess the reliability of treatment choices based on the TOI classification.

Main Methods:

  • Retrospective study of 213 AAD patients from July 2016 to January 2019 across four hospitals.
  • Classification based on etiology, disease course, flexion-extension X-rays, 3D CT, and skull traction response.
  • Interobserver and intraobserver agreement assessed using kappa statistics with 20 independent observers (8 specialists, 12 fellows).

Main Results:

  • The TOI system categorizes AAD into T (Traction reduction), O (Operation reduction), and I (Irreducible) types, with T further divided into T1 and T2 subtypes.
  • Interobserver reliability for TOI classification was moderate (κ = 0.543) and intraobserver reliability was substantial (κ = 0.658).
  • Reliability for treatment choice was also moderate (interobserver, κ = 0.568) to substantial (intraobserver, κ = 0.675), with no significant differences between specialists and fellows.

Conclusions:

  • The TOI classification system demonstrates satisfactory reliability for clinical application in managing atlantoaxial dislocation.
  • The system is suitable for use by surgeons with varying levels of experience, including orthopaedic fellows.
  • The TOI classification is expected to assist surgeons in selecting optimal treatment strategies for AAD patients.