Interobserver and intraobserver agreement for Letournel acetabular fracture classification system using 3-dimensional...

Area of Science:

• Orthopedic surgery
• Medical imaging
• Biomedical engineering

Background:

• Acetabular fractures present significant diagnostic and surgical challenges.
• The traditional Judet-Letournel classification relies solely on X-rays.
• Computed tomography (CT) and 3-D printing offer advanced visualization for complex fractures.

Purpose of the Study:

• To assess the reliability of the Judet-Letournel classification for acetabular fractures using CT imaging and 3-D printed models.
• To compare inter- and intra-observer agreement for fracture classification and surgical approach planning.

Main Methods:

• Pelvic CT scans from seven patients with acetabular fractures were used to create 3-D printed models.
• Eighteen orthopedic trauma surgeons completed questionnaires on fracture classification and surgical approach using CT and then 3-D models.
• Inter- and intra-observer agreement rates were statistically analyzed.

Main Results:

• Inter-observer agreement for fracture classification was moderate with CT (κ=0.44) and improved with 3-D models (κ=0.55).
• Agreement for preferred surgical approach was fair with CT (κ=0.34) and slightly decreased with 3-D models (κ=0.29).
• Intra-observer agreement for classification and approach was moderate with both modalities.

Conclusions:

• The Judet-Letournel classification shows only moderate agreement rates.
• 3-D printed models enhance inter-observer agreement in acetabular fracture classification.
• 3-D models improve spatial understanding and pre-operative planning for complex acetabular fractures.