¿El nuevo Sistema Unificado de Clasificación (SUC) de fracturas periprotésicas de cadera es más reproducible que la Clasificación de Vancouver?

Las fracturas periprotésicas son una complicación catastrófica que impacta la salud de los pacientes con artroplastias de cadera. El Sistema Unificado de Clasificación (SUC) fue desarrollado con el propósito de aplicar los principios de manejo de fracturas periprotésicas a cualquier reemplazo articular e incluir trazos de fracturas que el Sistema de Clasificación Vancouver (SCV) no contempla. El propósito de este estudio es evaluar y comparar la reproducibilidad de ambas clasificaciones.Background: The new Unified Classification System (UCS) was developed in order to extend the Vancouver Classification (VC). Whether this new classification is at least as reliable as the traditional VC, has not been determined yet. Question/Purpose: To assess and compare the reproducibility of both classification systems. Methods: Nineteen observers (11 hip and knee trained surgeons and 8 orthopedic residents) assessed the radiographs of 20 periprosthetic fractures of the hip and categorized each case according to the UCS and the VC. The intraobserver and interobserver agreement was evaluated with the AC2 statistic of Gwet with weights for partial agreements. Results: The interobserver agreement for UCS was 0. 57 (95% CI 0. 42 - 0. 73) and 0. 60 (95% CI 0. 35 - 0. 84) for the VC. This difference was not statistically significant (p=0. 82). The intraobserver agreement for USC was 0. 57 (95% CI 0. 50 - 0. 64) and 0. 70 (95% CI 0. 59 - 0. 82). This difference was not statistically significant either (p=0. 94). Conclusions: In spite of being a more detailed system, the new UCS is not superior in terms of reliability to the traditional VC. A deeper understanding of this new classification system is required before it is implemented in clinical practice