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Loisel F, Amar Y, Rochet S, Obert L. Distal humerus fracture in older patients: ORIF vs. total elbow arthroplasty. Orthop Traumatol Surg Res 2024; 110:103759. [PMID: 37992865 DOI: 10.1016/j.otsr.2023.103759] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 06/16/2023] [Indexed: 11/24/2023]
Abstract
Distal humerus fractures are a contemporary problem because the life expectancy, autonomy and functional demands of older patients continue to grow. This is combined with surgical advances in bone reconstruction, especially in fragile patients. A distal humerus fracture in an older adult is a serious injury with an uncertain prognosis. In fact, damage to the elbow joint in this complex anatomical area overwhelmed by low-quality bone occurs in patients who often have unfavorable characteristics (fragile skin, low physiological reserves, organ failure) combined with pharmaceutical treatments that can be iatrogenic. The treatment indication must not be based solely on the conventional radiographs used for classification purposes; the fracture and bone quality must be analyzed in three dimensions. Also, the surgeon must understand the patient's needs, worries and risks fully to decide between conservative treatment and anatomical locking plate fixation or elbow arthroplasty (hemi or total). In the end, the chosen treatment must allow at least 100̊ and preferably 120̊ of flexion-extension at the elbow. In this age range, the choice between arthroplasty and plate fixation is definitive; the surgical approach must make it possible to carry out either option, with arthroplasty implants available in case the trochlear fracture cannot be plated. The aim of this lecture is to provide a fresh perspective on the anatomy of the distal humerus, its fracture and the best surgical approaches, discuss how to decide on the indication, outline the safest and most reliable ways to reconstruct and stabilize the elbow, and lastly, summarize the expected outcomes and potential complications of each treatment option. Level of evidence: V; expert opinion.
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Affiliation(s)
- François Loisel
- Department of Orthopedic, Trauma, Plastic, Reconstructive and Hand Surgery, EA Laboratoire de Nano médecine Imagerie Thérapeutique (LNIT), CHRU of Besançon & CIC IT, 808, boulevard Fleming, 25033 Besançon, France
| | - Yassine Amar
- Department of Orthopedic, Trauma, Plastic, Reconstructive and Hand Surgery, EA Laboratoire de Nano médecine Imagerie Thérapeutique (LNIT), CHRU of Besançon & CIC IT, 808, boulevard Fleming, 25033 Besançon, France
| | - Severin Rochet
- Department of Orthopedic, Trauma, Plastic, Reconstructive and Hand Surgery, EA Laboratoire de Nano médecine Imagerie Thérapeutique (LNIT), CHRU of Besançon & CIC IT, 808, boulevard Fleming, 25033 Besançon, France
| | - Laurent Obert
- Department of Orthopedic, Trauma, Plastic, Reconstructive and Hand Surgery, EA Laboratoire de Nano médecine Imagerie Thérapeutique (LNIT), CHRU of Besançon & CIC IT, 808, boulevard Fleming, 25033 Besançon, France.
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Galloway JD, Shymon SJ, Adams MR, Reilly MC, Sirkin MS, Hreha J, Jung MT, Madi N, Siracuse BL, Ahmed I, Vosbikian MM. Distal Humerus Traction Radiographs: Is the Interobserver and Intraobserver Reliability Comparable With Computed Tomography? J Orthop Trauma 2022; 36:e265-e270. [PMID: 34924510 DOI: 10.1097/bot.0000000000002327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To compare the interobserver and intraobserver reliability of traction radiographs with 2-dimensional computed tomography (2D CT) in distal humerus fracture classification and characterization. DESIGN Randomized controlled radiographic review of retrospectively collected data. SETTING Academic Level 1 trauma center. PATIENTS/PARTICIPANTS Skeletally mature patients with intra-articular distal humerus fractures with both traction radiographs and CT scans were reviewed by 11 orthopaedists from different subspecialties and training levels. INTERVENTION The intervention involved traction radiographs and 2D CT. MAIN OUTCOME MEASUREMENTS The main outcome measurements included interobserver and intraobserver reliability of fracture classification by the OTA/AO and Jupiter-Mehne and determination of key fracture characteristics. RESULTS For the OTA/AO and Jupiter-Mehne classifications, we found a moderate intraobserver agreement with both 2D CT and traction radiographs (κ = 0.70-0.75). When compared with traction radiographs, 2D CT improved the interobserver reliability of the OTA/AO classification from fair to moderate (κ = 0.3 to κ = 0.42) and the identification of a coronal fracture from slight to fair (κ = 0.2 to κ = 0.34), which was more pronounced in a subgroup analysis of less-experienced surgeons. When compared with 2D CT, traction radiographs improved the intraobserver reliability of detecting stable affected articular fragments from fair to substantial (κ = 0.4 to κ = 0.67). CONCLUSIONS Traction radiographs provide similar diagnostic characteristics as 2D CT in distal humerus fractures. For less-experienced surgeons, 2D CT may improve the identification of coronal fracture lines and articular comminution.
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Affiliation(s)
- Joseph D Galloway
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | | | - Mark R Adams
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Mark C Reilly
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Michael S Sirkin
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Jeremy Hreha
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Michael T Jung
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Naji Madi
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | | | - Irfan Ahmed
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Michael M Vosbikian
- Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, NJ
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Byun SE, Shon OJ, Sim JA, Joo YB, Kim JW, Na YG, Choi W. Application of Three-Dimensional Computed Tomography Improved the Interrater Reliability of the AO/OTA Classification Decision in a Patellar Fracture. J Clin Med 2021; 10:jcm10153256. [PMID: 34362040 PMCID: PMC8347080 DOI: 10.3390/jcm10153256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022] Open
Abstract
We investigated whether interrater reliabilities of the AO/OTA classification of patellar fracture change with the imaging modalities applied, including plain radiography and two- and three-dimensional (2-D and 3-D) computed tomography (CT). Seven orthopedic specialists and four orthopedic residents completed a survey of 50 patellar fractures to classify the fractures according to the AO/OTA classification for patellar fractures. Initially, the survey was conducted using plain radiography only, then with 2-D CT introduced three weeks later and 3-D CT introduced six weeks later. Fleiss’ Kappa coefficients were calculated to determine interrater reliability. The overall interrater reliability of the AO/OTA classifications was 0.40 (95% CI, 0.38–0.42) with plain radiography only and 0.43 (95% CI, 0.41–0.45) with the addition of 2-D CT. With the addition of 3-D CT, the reliability was significantly improved to 0.54 (95% CI, 0.52–0.56). In specialists, interrater reliability of the classifications was moderate with all three imaging modalities. With the use of 3-D CT, interrater reliability of the classification was 0.53 (95% CI, 0.50–0.56), which was significantly higher than that with the use of 2-D CT (κ = 0.45; 95% CI, 0.42–0.48). In residents, interrater reliability of the classification was 0.30 (95% CI, 0.24–0.36) with plain radiography. The reliability improved to 0.49 (95% CI, 0.43–0.56) with the addition of 2-D CT, which was significantly higher than that with plain radiography only. The use of 3-D CT imaging improved interrater reliability of the classification. Therefore, surgeons, especially residents, may benefit from using 3-D CT imaging for classifying and planning the treatment of patellar fractures.
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Affiliation(s)
- Seong-Eun Byun
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam 13497, Korea;
| | - Oog-Jin Shon
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Daegu 42415, Korea;
| | - Jae-Ang Sim
- Department of Orhopaedic Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Korea;
| | - Yong-Bum Joo
- Department of Orhopaedic Surgery, Chungnam National University Hospital, Daejeon 35015, Korea;
| | - Ji-Wan Kim
- Department of Orthopaedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul 05505, Korea;
| | - Young-Gon Na
- Department of Orthopaedic Surgery, Seoul Segyero Hospital, Seoul 05790, Korea;
| | - Wonchul Choi
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam 13497, Korea;
- Correspondence: ; Tel.: +82-31-780-5289; Fax: +82-31-708-3578
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Morrey ME, Morrey BF, Sanchez-Sotelo J, Barlow JD, O'Driscoll S. A review of the surgical management of distal humerus fractures and nonunions: From fixation to arthroplasty. J Clin Orthop Trauma 2021; 20:101477. [PMID: 34211832 PMCID: PMC8237363 DOI: 10.1016/j.jcot.2021.101477] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Distal humeral fractures in adults are challenging injuries. They often require surgical intervention in form of internal fixation or total elbow arthroplasty which is being increasingly used in physiologically elderly patients with comminuted fractures. Careful preoperative evaluation including type of fracture, quality of bone, pre-existing conditions and functional demand help in deciding optimal treatment. CT scans including 2D and 3D reconstructions are almost mandatory in proper planning of the surgical treatment. In most cases with a healthy physiologically young patient, ORIF is the treatment of choice. Biomechanical studies have shown that parallel plating resists rotational deformity to a greater degree than 90/90 plating allowing supracondylar union. Accurate realignment of articular fragments and compression at the supracondylar area is key to the success of the internal fixation. Main cause of failure of fixation is the nonunion or malunion in the supracondylar area. The principles described by O'Driscoll et al. allow for rigid fixation of the distal articular fragments and compression at the supracondylar level which is vital to healing and the prevention of hardware failure, and nonunion. Olecranon osteotomy improves the expodure of distal humeral articular surface but has its own share of problems and should be avoided if possible. Irritation of ulnar nerve is a common complication so it should be isolated, kept under vision throughout and if necessary, transposed anteiriorly. Nonunion or malunion of supracondylar fractures can be treated by revision ORIF or total elbow arthroplasty (TEA). Supracondylar shortening, bone grafting and contracture release are important elements of treatment of nonunions. In unreconstructable distal humerus fractures, where open reduction and internal fixation is not possible due to the small size of the fragments, severe comminution and/or poor bone quality, TEA is the treatment of choice. Triceps can be left intact as the excision of fractured fragments usually provide enough space to carry out the operation. Sometimes, the decision to perform TEA is only made after exposing the fracture so the surgeon should be comfortable in performing TEA if ORIF is not possible; and necessary instruments and implants should be available on the shelf. In spite of satisfactory outcome, overall complication rate after TEA remains high and makes surgical efficiency and technical competence of utmost importance.
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Affiliation(s)
- Mark E. Morrey
- Corresponding author. Orthopaedic Surgery, Mayo Clinic, Rochester, MN, 55905, USA.
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Grogan BF, Danford NC, Lopez CD, Maier SP, Kongmalai P, Kovacevic D, Levine WN, Jobin CM. Number of screws in the articular segment of distal humerus AO/OTA C-type fractures treated with open reduction internal fixation is associated with complication rate. SICOT J 2021; 7:25. [PMID: 33812466 PMCID: PMC8019548 DOI: 10.1051/sicotj/2021006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 01/31/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction: Surgical treatment of distal humerus fractures can lead to numerous complications. Data suggest that the number of screws in the distal (articular) segment may be associated with complication rate. The purpose of this study is to evaluate the association between a number of screws in the distal segment and complication rate for surgical treatment of distal humerus fractures. We hypothesize that the number of screws in the articular segment of distal humerus AO/OTA C-type fractures treated with open reduction internal fixation (ORIF) will be inversely proportional to the complication rate. Methods: We performed a single-center retrospective cohort study of 27 patients who underwent ORIF of distal humerus fractures C-type with at least six months of radiographic and clinical follow-up. Clinical outcomes including a range of motion, pain, revision surgery for stiffness and/or heterotopic ossification (HO), nonunion, and persistent ulnar nerve symptoms requiring revision neurolysis were recorded. Results: In C-type fractures, the use of three or fewer articular screws was significantly associated with nonunion or loss of fixation (RR 17, p = 0.006). Nineteen of 36 (53%) patients experienced at least one complication. The surgical approach, plate configuration, age, and ulnar nerve treatment (none, in situ release, transposition) were not associated with the need for revision surgery. Men had a higher risk of requiring surgical contracture release due to improving post-operative stiffness (RR 12, p = 0.02). Conclusion: In this retrospective study, the use of three or fewer screws to fix articular fragments in AO type C fractures was a significant risk for nonunion or loss of fixation. Plate configuration and surgical approach did not correlate with outcomes. Men had higher rates of complications and required more frequent revision surgery compared to women.
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Affiliation(s)
- Brian F Grogan
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, 622 W. 168th St. PH-11, New York, 10032 NY, USA - Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, UW Health at The American Center, 4602 Eastpark Boulevard, Madison, 53718 WI, USA
| | - Nicholas C Danford
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, 622 W. 168th St. PH-11, New York, 10032 NY, USA
| | - Cesar D Lopez
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, 622 W. 168th St. PH-11, New York, 10032 NY, USA
| | - Stephen P Maier
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, 622 W. 168th St. PH-11, New York, 10032 NY, USA
| | - Pinkawas Kongmalai
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, 622 W. 168th St. PH-11, New York, 10032 NY, USA
| | - David Kovacevic
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, 622 W. 168th St. PH-11, New York, 10032 NY, USA
| | - William N Levine
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, 622 W. 168th St. PH-11, New York, 10032 NY, USA
| | - Charles M Jobin
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, 622 W. 168th St. PH-11, New York, 10032 NY, USA
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Lamas C, Grau A, Almenara M, Trigo L. Coronal shear fractures of the capitellum and trochlea: interobserver variability in classifying the fracture and the need for a computed tomography scan for the correct surgical planning. JSES Int 2020; 5:314-319. [PMID: 33681856 PMCID: PMC7910734 DOI: 10.1016/j.jseint.2020.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background To determine interobserver agreement in the classification by X-rays and by computed tomography (CT) scan of the coronal shear fractures of the capitellum and trochlea as well as the agreement between these two tests. Methods Patients with coronal shear fractures of the capitellum who were managed at our center between January 2008 and December 2017 were included. This retrospective cohort study was carried out with the approval of the ethics committee of our institution (Nº: IIBSP-Cod-2019-02, Ref. 19/070). Clinical, radiographic, and elbow-specific outcomes, including the Mayo Elbow Performance Index, were evaluated. Three observers analyzed the preoperative X-rays from all the cases. Each one of them independently classified the fractures according to the Bryan and Morrey classification (with the modification of McKee et al). The interobserver agreement was calculated by Cohen kappa coefficient. The same methodology was used to analyze the CT scan. Thereafter, one single value was determined for each X-ray and CT scan, from the good interobserver agreements. Finally, the agreement between the global X-ray classification and the global CT scan classification was calculated using the agreement percentage and the Cohen kappa coefficient. Results There were 3 males and 6 females, with a mean age of 47 years (range, 18-83). The mean follow-up period was 18 months (12-40). The average Mayo Elbow Performance Index score was 85 (range, 65-100) points. The complications were nonunion in one patient (11 %), degenerative arthritis in 7 (78 %), joint step-off in 5 (55%), and heterotopic ossification in 7 (78%). The agreement analysis between the global X-ray classification and the global CT scan classification showed a 57.1% agreement, with a kappa coefficient of −0.167. These values imply the absence of agreement. Conclusion Our results demostrated that simple X-rays do not allow for the adequate interpretation of distal humeral coronal plane fractures. Although an acceptable interobserver agreement was found, there is no agreement when the same fractures were analyzed by CT scan. The authors routinely recommend CT scan to assess the extent of the fracture and perform surgical planning.
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Affiliation(s)
- Claudia Lamas
- Hand Unit and Upper Extremity, Department of Orthopaedic Surgery, Hospital de la Santa Creu i Sant Pau. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alex Grau
- Hand Unit and Upper Extremity, Department of Orthopaedic Surgery, Hospital de la Santa Creu i Sant Pau. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Almenara
- Hand Unit and Upper Extremity, Department of Orthopaedic Surgery, Hospital de la Santa Creu i Sant Pau. Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luis Trigo
- Hand Unit and Upper Extremity, Department of Orthopaedic Surgery, Hospital de la Santa Creu i Sant Pau. Universitat Autònoma de Barcelona, Barcelona, Spain
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Value of three-dimensional computed tomography reconstruction in the treatment of posterior tibial plateau fractures. Knee 2020; 27:3-8. [PMID: 31883761 DOI: 10.1016/j.knee.2019.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 09/14/2019] [Accepted: 11/04/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Indication for surgical treatment of posterior tibial plateau fractures (TPFs) remains up for debate. Three-dimensional computed tomography (3D-CT) reconstruction can provide insight into fracture morphology and could improve treatment strategy and surgical planning. In this study, we investigated the value of 3D-CT reconstruction in the treatment of posterior TPF and evaluated the influence on surgical decision-making. METHODS CT images of 34 cases with a TPF involving the posterior column were included and digitally presented to a panel of five international observers at two intervals. At the first evaluation, only coronal, axial and sagittal images were shown. After an interval of at least three weeks, 3D-CT reconstruction images were added. During both surveys, observers were asked to classify the TPF according to the revised three-column classification (rTCC), as well as to define operative strategy. RESULTS When using 2D images, overall multirated kappa value was 0.48, with an average pairwise agreement of 68%. After adding 3D images, overall multirated kappa value was 0.43, with average pairwise agreement of 67%. Hierarchical logistic regression of decision to operate on image condition (3D vs. 2D) shows an odds ratio of 2.01 (95% confidence interval, 1.11-3.67), P = .022. Increase in operative indication was seen mainly in posterolateral fractures. CONCLUSION This study investigated the value of 3D classification in the treatment of posterior column TPF. Contrary to expectations, the addition of 3D images to the assessment did not reduce but rather appeared to increase operative indications, especially in fractures involving the posterolateral region.
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Byun SE, Choi W, Choi Y, Ahn TK, Kim HK, Yoon S, Lee J, Choi DS. Impact of two- and three-dimensional computed tomography use on intraobserver and interobserver reliabilities of pilon fracture classification and treatment recommendation. Orthop Traumatol Surg Res 2019; 105:1407-1412. [PMID: 31542310 DOI: 10.1016/j.otsr.2019.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 07/01/2019] [Accepted: 07/22/2019] [Indexed: 02/02/2023]
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 Rüedi-Allgöwer 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 6weeks 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.
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Affiliation(s)
- Seong-Eun Byun
- Department of Orthopedic Surgery, CHA Bundang Medical Center, CHA University, 59, Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Wonchul Choi
- Department of Orthopedic Surgery, CHA Bundang Medical Center, CHA University, 59, Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Youngrak Choi
- Department of Orthopedic Surgery, CHA Bundang Medical Center, CHA University, 59, Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
| | - Tae-Keun Ahn
- Department of Orthopedic Surgery, CHA Bundang Medical Center, CHA University, 59, Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Hyung Kyung Kim
- Department of Pathology, Kyung Hee University, Hospital of Gangdong, Seoul, Republic of Korea
| | - Sangchul Yoon
- Center for Global Health and Innovation, National Medical Center, Seoul, Republic of Korea
| | - Jongwook Lee
- Department of Applied Economics, University of Minnesota, Minneapolis, USA
| | - Dae-Sung Choi
- Department of Orthopedic Surgery, CHA Bundang Medical Center, CHA University, 59, Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea
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Garcia-Rey E, Garcia-Cimbrelo E. Distal Humerus Fractures: A Review of Current Literature. Open Orthop J 2019. [DOI: 10.2174/1874325001913010018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
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Claessen FMAP, Stoop N, Doornberg JN, Guitton TG, van den Bekerom MPJ, Ring D, Chauhan A, Wahegaonkar A, Shafritz A, Garcia G A, Miller A, Barquet A, Kristan A, Apard T, Armstrong A, Berner A, Jubel A, Kreis B, Babis C, Sutker B, Sears B, Nolan B, Crist B, Cross B, Wills B, Barreto C, Ekholm C, Swigart C, Oliveira Miranda C, Manke C, Zalavras C, Goldfarb C, Cassidy C, Walsh C, Jones C, Garnavos C, Young C, Moreno-Serrano C, Lomita C, Klostermann C, van Deurzen D, Rikli D, Polatsch D, Beingessner D, Drosdowech D, Eygendaal D, Patel M, Brilej D, Walbeehm E, Ballas E, Ibrahim E, Melamed E, Stojkovska Pemovska E, Hofmeister E, Hammerberg E, Kaplan F, Suarez F, Fernandes C, Lopez-Gonzalez F, Walter F, Frihagen F, Kraan G, Kontakis G, Dyer G, Kohut G, Panagopoulos G, Hernandez G, Porcellini G, Bayne G, Merrell G, DeSilva G, Della Rocca G, Bamberger H, Broekhuyse H, Durchholz H, Kodde I, McGraw I, Harris I, Pountos I, Wiater J, Choueka J, Kazanjian J, Gillespie J, Biert J, Fanuele J, Johnson J, Greenberg J, Abrams J, Hall J, Fischer J, Scheer J, Itamura J, Capo J, Braman J, Rubio J, Ortiz J, Filho J, Nolla J, Abboud J, Conflitti J, Abzug J, Patiño J, Rodríguez Roiz J, Adams J, Bishop J, Kabir K, Chivers K, Prommersberger K, Egol K, Rumball K, Dickson K, Jeray K, Poelhekke L, Campinhos L, Mica L, Borris L, Adolfsson L, Schulte L, Elmans L, Lane L, Paz L, Taitsman L, Guenter L, Austin L, Waseem M, Palmer M, Abdel-Ghany M, Richard M, Rizzo M, Pirpiris M, Di Micoli M, Bonczar M, Loebenberg M, Richardson M, Mormino M, Menon M, Soong M, Wood M, Meylaerts S, Darowish M, Nancollas M, Prayson M, Grafe M, Kessler M, Kaminaris M, Pirela-Cruz M, Mckee M, Merchant M, Tyllianakis M, Shafi M, Powell A, Shortt N, Felipe N, Parnes N, Bijlani N, Elias N, Akabudike N, Rossiter N, Lasanianos N, Kanakaris N, Brink O, van Eerten P, Paladini P, Martineau P, Appleton P, Levin P, Althausen P, Evans P, Jebson P, Krause P, Schandelmaier P, Peters A, Dantuluri P, Blazar P, Andreas P, Inna P, Quell M, Ramli R, de Bedout R, Ranade A, Ashish S, Smith R, Babst R, Omid R, Buckley R, Jenkinson R, Gilbert R, Page R, Papandrea R, Zura R, Gray R, Wagenmakers R, Pesantez R, van Riet R, Calfee R, van Helden S, Bouaicha S, Kakar S, Kaplan S, Scott F, Kaar S, Mitchell S, Rowinski S, Dodds S, Kennedy S, Beldner S, Schepers T, Guitton T, Gosens T, Baxamusa T, Taleb C, Tosounidis T, Wyrick T, Begue T, DeCoster T, Dienstknecht T, Varecka T, Mittlmeier T, Fischer T, Chesser T, Omara T, Bafus T, Siff T, Havlicek T, Sabesan V, Nikolaou V, Philippe V, Giordano V, Vochteloo A, Batson W, Hammert W, Satora W, Weil Y, Ruch D, Marsh L, Swiontkowski M, Hurwit S. Interpretation of Post-operative Distal Humerus Radiographs After Internal Fixation: Prediction of Later Loss of Fixation. J Hand Surg Am 2016; 41:e337-e341. [PMID: 27522299 DOI: 10.1016/j.jhsa.2016.07.094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 04/17/2016] [Accepted: 07/13/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE Stable fixation of distal humerus fracture fragments is necessary for adequate healing and maintenance of reduction. The purpose of this study was to measure the reliability and accuracy of interpretation of postoperative radiographs to predict which implants will loosen or break after operative treatment of bicolumnar distal humerus fractures. We also addressed agreement among surgeons regarding which fracture fixation will loosen or break and the influence of years in independent practice, location of practice, and so forth. METHODS A total of 232 orthopedic residents and surgeons from around the world evaluated 24 anteroposterior and lateral radiographs of distal humerus fractures on a Web-based platform to predict which implants would loosen or break. Agreement among observers was measured using the multi-rater kappa measure. RESULTS The sensitivity of prediction of failure of fixation of distal humerus fracture on radiographs was 63%, specificity was 53%, positive predictive value was 36%, the negative predictive value was 78%, and accuracy was 56%. There was fair interobserver agreement (κ = 0.27) regarding predictions of failure of fixation of distal humerus fracture on radiographs. Interobserver variability did not change when assessed for the various subgroups. CONCLUSIONS When experienced and skilled surgeons perform fixation of type C distal humerus fracture, the immediate postoperative radiograph is not predictive of fixation failure. Reoperation based on the probability of failure might not be advisable. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic III.
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Affiliation(s)
- Femke M A P Claessen
- Orthopaedic Hand and Upper Extremity Service, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Nicky Stoop
- Orthopaedic Hand and Upper Extremity Service, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Job N Doornberg
- Orthotrauma Research Center Amsterdam, University of Amsterdam Orthopaedic Residency Program, Amsterdam, The Netherlands
| | - Thierry G Guitton
- Orthotrauma Research Center Amsterdam, University of Amsterdam Orthopaedic Residency Program, Amsterdam, The Netherlands
| | | | - David Ring
- Orthopaedic Hand and Upper Extremity Service, Harvard Medical School, Massachusetts General Hospital, Boston, MA.
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Meijer DT, de Muinck Keizer RJO, Doornberg JN, Sierevelt IN, Stufkens SA, Kerkhoffs GMMJ, van Dijk CN. Diagnostic Accuracy of 2-Dimensional Computed Tomography for Articular Involvement and Fracture Pattern of Posterior Malleolar Fractures. Foot Ankle Int 2016; 37:75-82. [PMID: 26420736 DOI: 10.1177/1071100715603999] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Up to 44% of ankle fractures have involvement of the posterior tibial margin. Fracture size and morphology are important factors to guide treatment of these fragments, but reliability of plain radiography in estimating size is low. The aim of the current study was to evaluate the accuracy of 2-dimensional computed tomography (2DCT) in the assessment of posterior malleolar fractures. Additionally, the diagnostic accuracy of 2DCT and its value in preoperative planning was evaluated. METHODS Thirty-one patients with 31 ankle fractures including a posterior malleolar fragment were selected. Preoperative CT scans were analyzed by 50 observers from 23 countries. Quantitative 3-dimensional CT (Q3DCT) reconstructions were used as a reference standard. RESULTS Articular involvement of the posterior fragment was overestimated on 2DCT by factors 1.6, 1.4, and 2.2 for Haraguchi types I, II, and III, respectively. Interobserver agreement on operative management ("to fix, or not to fix?") was substantial (κ = 0.69) for Haraguchi type I fractures, fair (κ = 0.23) for type II fractures, and poor (κ = 0.09) for type III fractures. 2DCT images led to a change in treatment of the posterior malleolus in 23% of all fractures. Surgeons would operatively treat type I fractures in 63%, type II fractures in 67%, and type III fractures in 22%. CONCLUSION Surgeons overestimated true articular involvement of posterior malleolar fractures on 2DCT scans. 2DCT showed some additional value in estimating the involved articular surface when compared to plain radiographs; however, this seemed not yet sufficient to accurately read the fractures. Analysis of the CT images showed a significant influence on choice of treatment in 23% with a shift toward operative treatment in 12% of cases compared to evaluating plain lateral radiographs alone. LEVEL OF EVIDENCE Level III, comparative study.
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Affiliation(s)
- Diederik T Meijer
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Job N Doornberg
- University of Amsterdam Orthopaedic Residency Program (PGY5) and Postdoc Research Fellow, Orthotrauma Research Center Amsterdam, the Netherlands
| | - Inger N Sierevelt
- Department of Orthopaedic Surgery, Slotervaart Hospital, Amsterdam, the Netherlands
| | - Sjoerd A Stufkens
- University of Amsterdam Orthopaedic Residency Program (PGY5) and Postdoc Research Fellow, Orthotrauma Research Center Amsterdam, the Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, Academic Center for Evidence based Sports medicine (ACES), Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, the Netherlands
| | - C Niek van Dijk
- Academic Medical Center, Amsterdam, Amsterdam, the Netherlands
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