1. Radiographic Loss of Contact Between Radial Head Fracture Fragments Is Moderately Reliable
- Author
-
Daniel Hernandez, David R. Miller, Vispi Jokhi, Matthias Turina, J. C. Goslings, Parag Sancheti, J. L. Marsh, Parag Melvanki, Fred Baumgaertel, Charalampos G. Zalavras, Doug Hanel, Scott Edwards, Marc F. Swiontkowski, Jonathan Rosenfeld, Jason Fanuele, Brent Bamberger, Jeffrey Wint, Lisa L. Lattanza, Michael P. Leslie, Saul Kaplan, Matt Mormino, Loren Potter, Ronald Liem, Eric P. Hofmeister, Francisco Javier Aguilar Sierra, Jeremy A. Hall, Mahmoud I. Abdel-Ghany, Jonathan L. Hobby, Sanjev Jain, Taizoon Baxamusa, Martin I. Boyer, Reto Babst, Nikolaos K. Kanakaris, Gregory L. DeSilva, Ramon De Bedout, Ladislav Mica, Thomas B. Hughes, M. Jason Palmer, John S. Taras, Thomas A. DeCoster, Daphne M. Beingessner, Sanjeev Kakar, Lob Guenter, Arie B. van Vugt, Douglas T. Hutchinson, Hans J. Kreder, R. S. Gulve, J. Andrew, Henry Broekhuyse, Milind Merchant, Elena Grosso, David O. Oloruntoba, Nick Meyer, Iain McGraw, Michael Nancollas, Gustavo Mantovani Ruggiero, Rolf W. Peters, Antonio Barquet, Christopher J. Walsh, Thomas W. Wright, Pradeep Choudhari, Peter J. L. Jebson, Grant E. Garrigues, Richard Barth, Sander Spruijt, Scott F. M. Duncan, Taco Gosens, Thierry G. Guitton, Takashi Sasaki, Philipp Lenzlinger, Edward J. Harvey, Richard Buckley, Qiugen Wang, Platz Andreas, K.J. Ponsen, John Glenden DeVine, Peter Kloen, David Ring, Wendy E. Bruinsma, Jose A. Ortiz, Rodrigo Pesantez, Lawrence Weiss, Michael A. Prayson, Denise Eygendaal, Alberto Pérez Castillo, Edward C. Yang, Ross Leighton, John A. McAuliffe, Frede Frihagen, Amal Basak, Clifford B. Jones, Boyd Lumsden, Edward K. Rodriguez, Brett D. Crist, Martin Richardson, James F. Kellam, Kendrick E. Lee, W. Arnnold Batson, Shep Hurwit, Michael W. Grafe, Todd E. Siff, David Weiss, George L. Thomas, Scott A. Mitchell, Steve Helgemo, Ben Sutker, Joseph M. Conflitti, James Wagg, Toni M. McLaurin, Michael H.J. Verhofstad, Richard L. Uhl, Robert D. Zura, Eric Mark Hammerberg, John Wixted, Jorge G. Boretto, Frank L. Walter, Ian A. Harris, Waldo E. Floyd, Michael A. Baskies, John Howlett, I. Trenholm, Peter L. Althausen, Rozental, Brad Petrisor, John T. Bolger, Raymond Malcolm Smith, Rena Stewart, Leon Elmans, David B. Carmack, Ekkehard Bonatz, David M. Kalainov, George M. Kontakis, Rick F. Papandrea, Andrew H. Schmidt, Julie E. Adams, I. J.V. Kleinlugtenbelt, Gregory J. Della Rocca, Charles Cassidy, Catherine Spath, Lars C. Borris, Fabio Suarez, Chris Wilson, Jim Calandruccio, Sidney M. Jacoby, Thomas J. Fischer, Daniel B. Polatsch, Peter Schandelmaier, Jose Nolla, Richard S. Page, Kenneth A. Egol, Steven J. Rhemrev, Alan Kawaguchi, Timothy G. Havenhill, Jay Pomerance, Patrick T. McCulloch, Richard Jenkinson, Fryda Medina Rodríguez, Bernhard Ciritsis, Abhijeet L. Wahegaonkar, Charles Metzger, Vishwanath M. Iyer, Carrie R. Swigart, Lisa Taitsman, Leon S. Benson, Rudolf W. Poolman, Kyle J. Jeray, Peter R. Brink, Niels W. L. Schep, Marc J. Richard, Kevin Eng, Russell Shatford, George S.M. Dyer, Orthopedic Surgery and Sports Medicine, Surgery, Other Research, Other departments, AMS - Amsterdam Movement Sciences, and Graduate School
- Subjects
Joint Instability ,Male ,medicine.medical_specialty ,Sports medicine ,Radiography ,Elbow ,Forearm ,Predictive Value of Tests ,Elbow Joint ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Observer Variation ,Orthodontics ,business.industry ,Reproducibility of Results ,General Medicine ,Anatomy ,Prognosis ,musculoskeletal system ,body regions ,Radius ,medicine.anatomical_structure ,Symposium: Traumatic Elbow Instability and its Sequelae ,Elbow dislocation ,Orthopedic surgery ,Ligament ,Female ,Surgery ,Radial head fracture ,Clinical Competence ,Radius Fractures ,Elbow Injuries ,business ,Specialization - Abstract
Loss of contact between radial head fracture fragments is strongly associated with other elbow or forearm injuries. If this finding has adequate interobserver reliability, it could help examiners identify and treat associated ligament injuries and fractures (eg, forearm interosseous ligament injury or elbow dislocation). (1) What is the interobserver agreement on radiographic loss of contact between radial head fracture fragments? (2) Are there factors associated with the observer such as location of practice or subspecialization that increase interobserver reliability? Fully trained practicing orthopaedic and trauma surgeons from around the world evaluated 27 anteroposterior and lateral radiographs of radial head fractures on a web-based platform for the following characteristics: (1) loss of contact between at least one radial head fracture fragment and the remaining radial head and neck; (2) a gap between fragments of 2 mm or greater; (3) anticipated fracture instability (mobility) on operative exposure; (4) anticipated associated ligament injuries; and (5) recommendation for treatment. Agreement among observers was measured using the multirater kappa measure. Kappas for various observer characteristics were compared using 95% confidence intervals. The overall interobserver agreement was moderate (range, 0.49-0.55) for each question except associated ligament injury, which was fair (0.33). Shoulder and elbow surgeons had substantial agreement (range, 0.51-0.61) in many areas, but kappas were generally in the moderate range (0.41-0.59) based on number of years in practice, radial head fractures treated per year, and trainee supervision. Radiographic signs of radial head fracture instability such as loss of contact have moderate reliability. This characteristic seems clinically useful, because loss of contact between at least one radial head fracture fragment and the remaining radial head and neck is strongly associated with associated ligament injury or other fractures. Level III, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence
- Published
- 2014
- Full Text
- View/download PDF