Interobserver Reliability of Classification Systems to Rate the Quality of Femoral Neck Fracture Reduction
Bibliographic record
Abstract
OBJECTIVES: We compared the interrater reliability of five classification systems and surgeons' global impressions of the quality of femoral neck fracture reduction. METHODS: Six orthopedic trauma surgeons, six orthopedic nontrauma surgeons, and six orthopedic residents from three sites each rated 50 radiographs of postoperative femoral neck fractures fixated with cannulated screws or a sliding hip screw, using their overall impression, the Garden Index, Lowell's criteria, Lindquist and Tornkvist's criteria, the Western Infirmary Glasgow (WIG) angle, and standards established by a working group of orthopedic trauma surgeons. RESULTS: Reliability estimates for the Garden Index, Lowell's criteria, and the working group standards all fell within the range of moderate agreement [intraclass correlation coefficient (ICC) range 0.41-0.48], with no instrument achieving higher reliability than reviewers' overall impressions (ICC 0.49, 95% CI 0.39-0.61). Reviewers reached only fair agreement using Lindquist and Tornkvist's criteria and the WIG angle (kappa = 0.27 and 0.39, respectively). Trauma surgeons consistently achieved higher agreement than did nontrauma surgeons and trainees. CONCLUSIONS: Future studies using quality of reduction as an outcome measure or exploring the prognostic importance of reduction quality should measure this with trauma surgeons' overall impression, rather than with less experienced assessors or using one of the alternative instruments.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".