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Introduction The AO/OTA classification for diagnosing femoral trochanteric fractures (31A fractures) was revised in 2018. No studies have investigated whether the addition of CT to radiographic diagnosis improves the inter-rater reliability of classifying 31A fractures with the current AO/OTA criteria. The study aimed to test the hypothesis that the addition of three-dimensional CT (3D-CT) to radiographic diagnosis would improve diagnostic reliability. Methods A retrospective review was conducted to assess the diagnostic reliability of classification of 31A fractures with current AO/OTA criteria. Radiographs and 3D-CT images from 89 cases were assessed. Major fracture types (A1, A2, and A3) and subgroups were diagnosed by nine orthopedic surgeons who were classified into three groups (high-, intermediate-, and low-experience) according to their clinical experience. Anterior–posterior and lateral radiographs were provided to diagnose fracture type (first assessment). After a 6-week interval, radiographs and 3D-CT images of all cases were evaluated by each rater (second assessment). Fleiss's Kappa was used to determine inter-rater reliability. Results In the first assessment, the Kappa value indicated fair inter-rater reliability in all groups (high-experience group: κ = 0.296, 95% confidence interval [CI] 0.239–0.352; intermediate-experience group: κ = 0.367, 95% CI 0.305–0.428; low-experience group: κ = 0.304, 95% CI 0.246–0.362). With the addition of 3D-CT (second assessment), reliability improved from fair to moderate in the high- and intermediate-experience groups (κ = 0.483, 95% CI 0.428–0.539 and κ = 0.409, 95% CI 0.352–0.466, respectively). By contrast, reliability remained fair in the low-experience group (κ = 0.322, 95% CI 0.322–0.431). The inter-rater reliability of diagnosing subgroup fracture types improved for A2.3 and A3.1 in all three groups and for A3.2 and A3.3 in the intermediate- and low-experience groups. Conclusion The current AO/OTA classification revised in 2018 provided fair reliability in diagnosing femoral trochanteric fractures in all three surgeon groups. The addition of 3D-CT to radiographic image evaluation improved reliability in high- and middle-expertise groups. The addition of 3D-CT to radiographic evaluation often improved the diagnostic reliability for unstable fractures, although there was some variation among fracture subgroups.

Background A tibial plateau fracture is one of the most challenging fractures for both knee and trauma surgeons because of the high incidence of post-traumatic knee osteoarthritis. To our knowledge, there has been no study concerning the clinical outcomes after surgery in patients with non-union of complex intra-articular tibial plateau fractures. Thus, the present study aimed to assess and report the clinical outcomes in them. Methods The study included four patients with non-union of complex tibial plateau fractures who underwent failed initial fixation treatment or could not undergo initial fixation owing to concomitant injury and who were followed up with a diagnosis of non-union for a minimum of 6 months. At the latest follow-up, patient-reported outcome measures, including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Oxford 12-item Knee Score (OKS), were assessed. Additionally, the knee range of motion (ROM) was evaluated. Results The mean duration from the initial surgery to revision surgery was 8.8 months, and the mean duration from the revision surgery to fracture union was 4.8 months. At the latest follow-up, the mean WOMAC score was 9.8 and the mean OKS was 43.5. Additionally, the mean knee ROM values were −11 degrees of extension and 100 degrees of flexion. All four patients had become able to walk without any aid after averaged 4.5-years follow up. Conclusion Favorable clinical outcomes can be achieved following revision surgery involving open reduction and IF in patients with non-union of complex tibial plateau fractures after failed initial treatment. Level of evidence Level IV, Case report.

The factors for poor adherence to therapy in patients with postoperative fracture who are treated with low-intensity pulsed ultrasound remain unknown. Therefore, we designed a retrospective cohort study to determine the various factors for poorer adherence to therapy in patients with postoperative fracture who were treated with low-intensity pulsed ultrasound therapy.We retrospectively analyzed the data of postoperative patients who underwent low-intensity pulsed ultrasound after fracture surgery from January 2010 to May 2019. The patients were categorized into two groups as follows: group G, including those with a good adherence rate (72%), and group P, including those with a poor adherence rate (72%). Factors, such as age, sex, how the rental cost of low-intensity pulsed ultrasound was paid (by the patients themselves or by the insurance company), living (alone or with someone), insurance claim item (fractures within 3 weeks after osteosynthesis or delayed or non-union fractures), low-intensity pulsed ultrasound device-type (earlier- or next-generation), duration of low-intensity pulsed ultrasound use, fracture site (upper or lower limb), frequency of hospital visits (regular or irregular), and employment status (employed/unemployed) were compared between groups G and P.In total, 96 patients (74 and 22 patients in groups G and P, respectively) who underwent low-intensity pulsed ultrasound were included in the study. Univariate analysis revealed that younger patients (P 0.001) and patients who did not regularly visit the hospital (P = 0.024) were more likely to have poorer adherence to therapy. Multiple logistic regression analysis revealed that age was the only independent, pertinent factor for poorer adherence to therapy (odds ratio, 8.570; 95% confidence interval, 2.770-26.50; P 0.001), with a cutoff value of 41 years.Younger age is a significant factor for poorer adherence in patients undergoing low-intensity pulsed ultrasound therapy.