1. Impact of two- and three-dimensional computed tomography use on intraobserver and interobserver reliabilities of pilon fracture classification and treatment recommendation
- Author
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Youngrak Choi, Dae-Sung Choi, Sangchul Yoon, Jongwook Lee, Hyung Kyung Kim, Tae-Keun Ahn, Wonchul Choi, and Seong-Eun Byun
- Subjects
medicine.medical_specialty ,Intra-Articular Fractures ,Interobserver reliability ,Radiography ,Computed tomography ,Ankle Fractures ,Pilon fracture ,03 medical and health sciences ,Imaging, Three-Dimensional ,0302 clinical medicine ,Fracture Fixation ,medicine ,Humans ,Orthopedics and Sports Medicine ,030222 orthopedics ,medicine.diagnostic_test ,business.industry ,Reproducibility of Results ,Treatment options ,030229 sport sciences ,medicine.disease ,Surgery ,Tibial Fractures ,ROC Curve ,Case-Control Studies ,Orthopedic surgery ,Plain radiographs ,Tomography, X-Ray Computed ,Nuclear medicine ,business ,Kappa - Abstract
Background Two-dimensional (2D) and three-dimensional (3D) computed tomography (CT) have been increasingly used in various intra-articular fractures including pilon fracture. However, no study has investigated intraobserver and interobserver reliabilities of pilon fracture classification using 3D CT images. Hypothesis (1) Intraobserver and interobserver agreements of fracture classifications and treatment recommendations will improve by using 2D CT images compared to using plain radiographs only; (2) agreements will improve by adding 3D CT images compared to adding 2D CT images; and (3) agreements of orthopedic residents rather than specialists will be influenced more by imaging modality. Materials and methods Ten orthopedic specialists and 10 residents completed a survey to classify the fractures according to the Ruedi-Allgower and AO/OTA classifications and to select treatment options using 25 pilon fracture images. The survey was conducted using plain radiographs, with 2D and 3D CT images introduced 3 and 6 weeks later, respectively. Kappa coefficients were calculated to determine reliabilities. Results Intraobserver reliabilities for fracture classifications in specialists significantly improved by using 2D images compared to using plain radiographs only. Addition of 3D CT did not significantly improve intraobserver reliabilities compared to those with 2D CT. Use of 2D CT images significantly improved overall interobserver agreement of both classifications, with the improvement being greater for residents. Use of 3D CT images did not improve the interobserver reliability of both classifications. Overall interobserver reliabilities for treatment recommendations did not significantly differ according to the imaging modality. However, interobserver agreement among residents significantly improved from slight agreement using radiographs only to fair agreement using 2D CT images. Discussion Intraobserver and interobserver reliabilities of pilon fracture classification and treatment recommendations did not improve between using 3D and 2D CT. Using 2D CT images improved the intraobserver and interobserver reliabilities of the fracture classifications in specialists and the interobserver reliabilities of the fracture classifications and the treatment recommendations in residents. Level of evidence IV, case control study.
- Published
- 2019