Evaluation of the Inter and Intra-Observer Reliability of the AO Classification of Intertrochanteric Fractures and the Device Choice (DHS, PFNA, and DCS) of Fixations

BACKGROUND:ArbeitsgemeinschaftfürOsteosynthesefragen (AO) classification is the most frequently used tool to classify intertrochanteric fractures. However, there is limited evidence regarding its reliability. Therefore, this study was designed to evaluate inter-observer and intra-observer reliability of the AO-2018 intertrochanteric fracture classification.METHOD: A retrospective study was conducted in Imam Khomeini Hospital Complex, on radiography of patients who came with intertrochanteric fractures from March 21, 2018, to March 19, 2019. Four orthopedic trauma surgeons assessed 96 anteroposterior pelvic radiographs of intertrochanteric fractures and classified using an AO intertrochanteric fracture classification of 2018. The reading and review of radiography were performed in 2 separate occasions in a 1-month interval. The inter-observer and intra-observer reliability was assessed using kappa statistics.RESULT: The level of both mean inter-observer (K =0.322; 95%CI: 0.321-0.323) and intra-observer agreement (K =0.317; 95%CI: 0.314-0.320) in AO intertrochanteric fracture classification subgrouping were not satisfactory. The inter-observer (K =0.61; 95%CI: 0.608-0.611) and intra-observers’ (K=0.560;95%CI: 0.544-0.566) reliability in AO main groupings showed moderate agreement.CONCLUSION: The AO classification does not show adequate and acceptable inter-observer and intra-observer reliability and reproducibility. Therefore, it will be hard to base on the AO classification for treatment protocols

The Effect of Greater Occipital Nerve Block on Chronic Migraine

Background: Greater occipital never block has been shown to be an effective treatment in patients with cluster or tension type headache but there are very few studies investigating its effect in patients with chronic migraine. This study was to determine the effectiveness of greater occipital never block on headache in patients with chronic migraine. We designed an interventional before-after study for patients suffered from chronic migraine.Methods: Patients were participated in this study according to inclusion and exclusion criteria. Frequency, severity and duration of headaches were recorded by patients 2 weeks before injection and then during 6 weeks after injection. We compared data recorded before injection to data from each two-week after injections to determine the effectiveness of greater occipital never block in improvement of headaches in patients with chronic migraine.Results: Fourteen patients (mean age=34.21±2.75) were included in the study. Number of attacks was significantly decreased during 6 weeks follow up (p<0.05). Mean headache severity was significantly decreased during first and second two-week follow up by 3.04 and 2.39 points, respectively. Duration of headaches was not significantly reduced during follow up.Conclusion: In conclusion, Greater occipital nerve block can improve the status of headache in patients with chronic migraine by decreasing the severity and frequency of headaches. However, it may not be effective in shortening the duration of headaches