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Inter- and intraobserver reliability of non-weight-bearing foot radiographs compared with CT in Lisfranc injuries
- Source :
- Archives of Orthopaedic and Trauma Surgery
- Publication Year :
- 2020
- Publisher :
- Springer Science and Business Media LLC, 2020.
-
Abstract
- BackgroundInjury of the tarsometatarsal (TMT) joint complex, known as Lisfranc injury, covers a wide range of injuries from subtle ligamentous injuries to severely displaced crush injuries. Although it is known that these injuries are commonly missed, the literature on the accuracy of the diagnostics is limited. The diagnostic accuracy of non-weight-bearing radiography (inter- or intraobserver reliability), however, has not previously been assessed among patients with Lisfranc injury.MethodsOne hundred sets of foot radiographs acquired due to acute foot injury were collected and anonymised. The diagnosis of these patients was confirmed with a CT scan. In one-third of the radiographs, there was no Lisfranc injury; in one-third, a nondisplaced (ResultsFleiss kappa (κ) coefficient for interobserver reliability resulted in moderate correlation κ = 0.50 (95% CI: 0.45– 0.55) (first evaluation) and κ = 0.58 (95% CI: 0.52–0.63) (second evaluation). After three months, the evaluation was repeated and the Cohen’s kappa (κ) coefficient for intraobserver reliability showed substantial correlation κ = 0.71 (from 0.64 to 0.85). The mean (range) sensitivity was 76.1% (60.6–92.4) and specificity was 85.3% (52.9–100). The sensitivity of subtle injuries was lower than severe injuries (65.4% vs 87.1%p = 0.003).ConclusionsDiagnosis of Lisfranc injury based on non-weight-bearing radiographs has moderate agreement between observers and substantial agreement between the same observer in different moments. A substantial number (24%) of injuries are missed if only non-weight-bearing radiographs are used. Nondisplaced injuries were more commonly missed than displaced injuries, and therefore, special caution should be used when the clinical signs are subtle.Level of evidenceIII.
- Subjects :
- medicine.medical_specialty
Radiography
Trauma Surgery
Injury
Fleiss' kappa
Sensitivity and Specificity
X-ray
Intraobserver
03 medical and health sciences
0302 clinical medicine
Lisfranc
Humans
Medicine
Orthopedics and Sports Medicine
Foot Injuries
Observer Variation
030222 orthopedics
Lisfranc injury
Interobserver
Missed Diagnosis
business.industry
Intraobserver reliability
Responsiveness
Orthopedic Surgeons
030229 sport sciences
General Medicine
Reliability
medicine.disease
Orthopedic surgery
Crush injury
Surgery
Radiographs
Radiology
Foot Injury
Tomography, X-Ray Computed
business
Kappa
Subjects
Details
- ISSN :
- 14343916 and 09368051
- Volume :
- 140
- Database :
- OpenAIRE
- Journal :
- Archives of Orthopaedic and Trauma Surgery
- Accession number :
- edsair.doi.dedup.....987a5b40ddbf672b5428620b4d91d320