Internal Rotation Traction Radiograph Improves Proximal Femoral Fracture Classification Accuracy and Agreement

OBJECTIVE. The objective of this study is to assess the clinical utility of internal rotation traction radiography in the classification of proximal femoral fractures. MATERIALS AND METHODS. The study cohort included 78 consecutive patients who were surgically treated for a proximal femoral fracture and for whom preoperative physician-assisted internal rotation traction radiographs of the fractured hip were obtained in addition to standard radiographs. Two radiologists who were blinded to clinical information independently classified each fracture without the traction view and then with the traction view. The radiologists also reported their confidence (expressed as a percentage) in their classifications. The reference standard was the consensus interpretation of intraoperative C-arm fluoroscopic images by two orthopedic surgeons and one radiologist. Classification accuracy was compared using the McNemar test. Subjective confidence and confidence-weighted accuracy were compare using paired t tests. Agreem...