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Figure 1. Preoperative anteroposterior radiograph showing a left nondisplaced femoral neck fracture. The patient was a 71 year old woman of 140 cm height and 34 kg weight (body mass index 17.3 kg/m2). We did not exclude the images that were difficult to measure due to the influence of soft tissues or radiation dose.
Figure 2. Garden alignment index using a preoperative anteroposterior radiograph. The angle of GAI is denoted by α.
Figure 3. Valgus tilt measurement using preoperative anteroposterior radiographs. First, the mid-neck line (MNL) was drawn through the center of two lines across the residual mid-femoral neck; the first line was drawn at the narrowest part of the residual mid-femoral neck, and a second parallel line was drawn 5 mm distal to the first line. Second, the femoral head line (FHL) was drawn from the center (C) of the femoral head circle to the point where the MNL crossed the femoral head circle. Lastly, the valgus tilt (α) was the angle formed by the MNL and FHL.
Figure 3. Valgus tilt measurement using preoperative anteroposterior radiographs. First, the mid-neck line (MNL) was drawn through the center of two lines across the residual mid-femoral neck; the first line was drawn at the narrowest part of the residual mid-femoral neck, and a second parallel line was drawn 5 mm distal to the first line. Second, the femoral head line (FHL) was drawn from the center (C) of the femoral head circle to the point where the MNL crossed the femoral head circle. Lastly, the valgus tilt (α) was the angle formed by the MNL and FHL.
Figure 4. Image of measurement difficulties by valgus tilt measurement.
Table 1. Intra-rater reliability of the Garden alignment index and valgus tilt measurement for four raters in 50 hip radiographs.
Table 1. Intra-rater reliability of the Garden alignment index and valgus tilt measurement for four raters in 50 hip radiographs.
Garden AlignmentTable 2. Inter-rater reliability of the Garden alignment index and valgus tilt measurement for four raters in 50 hip radiographs.
Table 2. Inter-rater reliability of the Garden alignment index and valgus tilt measurement for four raters in 50 hip radiographs.
Garden Alignment IndexValgus Tilt MeasurementDifference ICC (95% CI)ICC (95% CI)Point Estimate (95% CI)Four raters0.92 (0.89–0.95)0.85 (0.81–0.88)0.08 (0.03–0.13)Two senior surgeons0.95 (0.91–0.98)0.90 (0.83–0.94) Two junior surgeons0.95 (0.91–0.97)0.95 (0.91–0.97)Table 3. Intra- and inter-rater reliability of the Garden alignment index and valgus tilt measurement for four raters in patients aged ≥80 years vs. aged <80 years.
Table 3. Intra- and inter-rater reliability of the Garden alignment index and valgus tilt measurement for four raters in patients aged ≥80 years vs. aged <80 years.
PatientsMeasurementIntra-Rater Reliability
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