DO TRACTION-INTERNAL ROTATION X-RAYS HAVE AN AFFECT ON THE TREATMENT OPTIONS OF PROXIMAL FEMUR FRACTURES AMONG ORTHOPEDIC SURGEONS WITH DIFFERENT LEVELS OF EXPERTISE?

<strong>Objective:</strong> The purpose of the current study was to investigate whether the traction-internal rotation X-ray used in proximal femur fractures actually alters the implant choice among 12 different levels of expertise orthopaedic surgeons. <strong>Material and Methods:</strong> The radiographs of 50 patients who were treated due to proximal femur fracture in our clinic were identified retrospectively. Twelve orthopaedic surgeons evaluated the patient X-rays in two different rounds, two weeks apart. Each observer was asked to independently examine the anteroposterior radiographs of both hips in the first round and the traction-internal rotation radiographs in the second round. Inter-observer agreement was determined using the Fleiss’ Kappa statistic, while intra-observer agreement was calculated using the Kappa statistic. <strong>Results:</strong> A total of 50 patients with proximal femur fractures were included in our study. 26 of the patients were female (52%) and 24 (48%) were male. The average age of the participants was 70 (50±94). The implant options were as follows: total hip arthroplasty, hemiarthroplasty, proximal femur nail, long femur nail, 95° AO blade plate, anatomical plate, cannulated screw and dynamic hip screw. The intraobserver agreement was found to be moderate to substantial (κ=0.44-0.68) in consultant trauma surgeons, moderate in senior orthopaedic surgeons (κ=0.47-0.56) and fair to moderate (κ=0.24-0.59) in orthopaedic residents. The&nbsp;inter-observer agreement was moderate to substantial between consultant trauma surgeons (κ=0.56-0.62), moderate agreement between senior orthopaedic surgeons and fair agreement between orthopaedic residents respectively (κ=0.45, κ=0.30). <strong>Conclusion: </strong>Traction radiography is crucial in the proper classification of proximal femur fractures in accordance with the literature. This study shows that as professional experience increases, traction radiography increases the consistency in surgical implant selection.