J Korean Orthop Res Soc.  2010 Dec;13(2):60-67.

Evaluation the Reliability of Singh Index in Elderly Patients with Proximal Femoral Fractures Using Digital Radiographic Image

• Yun HH
• Kang JW
• Lee GY
• Lee JW
• Lee JW
• Jang HW
• Park SC

Abstract

PURPOSE
To evaluate the reliability of Singh index (SI) values, determined on image software processed digital radiographs in elderly patients with proximal femoral fractures, with respect to its value as a simple and inexpensive method to evaluate osteoporosis in acute trauma situations.
MATERIALS AND METHODS
The authors retrospectively reviewed 210 patients (98 femur neck fractures, 112 intertrochanter fractures) treated between March 2005 and March 2009. Preoperative digital radiographs of each patient were assessed by four observers to determine SI values. The reliability of SI was expressed in terms of intraobserver and interobserver agreements in pairs using Fleiss's overall Kappa, Stuart's tau-c index, and Kendall's coefficiency of concordance.
RESULTS
Fleiss's overall kappa values for intraobserver agreement ranged from 0.278 to 0.586 (mean, 0.452) and did not reach good reliability overall. Fleiss's overall kappa values for interobserver agreement ranged from 0.120 to 0.241 (mean, 0.180), and thus, did not reach acceptable reliability.
CONCLUSION
The result suggest that the image adjustment tools provided by digital radiography cannot improve the usefulness of SI as a simple and inexpensive method of assessing the osteoporosis. Therefore, the reliability of SI good enough to be used for clinical and research work is questionable.

Keyword

Hip; Proximal femoral fractures; Osteoporosis; Singh index; Digital radiographic image

MeSH Terms

Aged
Femoral Fractures
Femoral Neck Fractures
Hip
Humans
Osteoporosis
Radiographic Image Enhancement
Retrospective Studies