Seinsheimer's classification of subtrochanteric fractures: Poor reproducibility of 4 observers' evaluation of 50 cases

We examined the reliability of the Seinsheimer classification of subtrochanteric fractures of the femur. 50 consecutive anteroposterior and lateral radiographs were assessed independently by 4 observers twice with a 6-week interval. The interobserver variation was large; only 13 of the 50 fractures were classified identically by all 4 observers. The intraobserver variation showed identical classification in 26-37 of 50 radiographs. When assessing only whether the fracture was subtype 3A or not, the 4 observers agreed in 31 of 50 radiographs. We conclude that the Seinsheimer classification has no value in clinical practice.