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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Claessen FMAP, van den Ende KIM, Doornberg JN, Guitton TG, Eygendaal D, van den Bekerom MPJ, Schep N, Boerboom A, van der Pluim M, Wagener M, Beumer A, Kloen P, Keijser C, van Deurzen D, Mansat P, Somford M, Jaspars C, Kolovich G, Cheung J, van Tongel A, Blokzijl R, Heijnk A, Alta T, Lambers Heerspink O, van Deurzen-van Dijk P, van Noort A, Lisowski L, Ekholm C, Shafritz A, Garrigues G, Porcellini G, Mazzocca A, Kaar S, Duncan S, Patel M, Patiño J, Paladini P. Osteochondritis dissecans of the humeral capitellum: reliability of four classification systems using radiographs and computed tomography. J Shoulder Elbow Surg 2015; 24:1613-8. [PMID: 25953486 DOI: 10.1016/j.jse.2015.03.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 03/18/2015] [Accepted: 03/18/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND The radiographic appearance of osteochondritis dissecans (OCD) of the humeral capitellum varies according to the stage of the lesion. It is important to evaluate the stage of OCD lesion carefully to guide treatment. We compared the interobserver reliability of currently used classification systems for OCD of the humeral capitellum to identify the most reliable classification system. METHODS Thirty-two musculoskeletal radiologists and orthopaedic surgeons specialized in elbow surgery from several countries evaluated anteroposterior and lateral radiographs and corresponding computed tomography (CT) scans of 22 patients to classify the stage of OCD of the humeral capitellum according to the classification systems developed by (1) Minami, (2) Berndt and Harty, (3) Ferkel and Sgaglione, and (4) Anderson on a Web-based study platform including a Digital Imaging and Communications in Medicine viewer. Magnetic resonance imaging was not evaluated as part of this study. We measured agreement among observers using the Siegel and Castellan multirater κ. RESULTS All OCD classification systems, except for Berndt and Harty, which had poor agreement among observers (κ = 0.20), had fair interobserver agreement: κ was 0.27 for the Minami, 0.23 for Anderson, and 0.22 for Ferkel and Sgaglione classifications. The Minami Classification was significantly more reliable than the other classifications (P < .001). CONCLUSIONS The Minami Classification was the most reliable for classifying different stages of OCD of the humeral capitellum. However, it is unclear whether radiographic evidence of OCD of the humeral capitellum, as categorized by the Minami Classification, guides treatment in clinical practice as a result of this fair agreement.
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Affiliation(s)
- Femke M A P Claessen
- Orthotrauma Research Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands; Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA.
| | | | - Job N Doornberg
- Orthotrauma Research Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Thierry G Guitton
- Orthotrauma Research Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Denise Eygendaal
- Upper Limb Unit, Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
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