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Interobserver reliability of radial head fracture classification : two-dimensional compared with three-dimensional CT

Guitton, Thierry G., Ring, David, Page, Richard S. and Science of Variation Group 2011, Interobserver reliability of radial head fracture classification : two-dimensional compared with three-dimensional CT, Journal of bone and joint surgery, vol. 93, no. 21, pp. 2015-2021, doi: 10.2106/JBJS.J.00711.

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Title Interobserver reliability of radial head fracture classification : two-dimensional compared with three-dimensional CT
Author(s) Guitton, Thierry G.
Ring, David
Page, Richard S.ORCID iD for Page, Richard S. orcid.org/0000-0002-2225-7144
Science of Variation Group
Contributor(s) Page, Richard S.ORCID iD for Page, Richard S. orcid.org/0000-0002-2225-7144
Journal name Journal of bone and joint surgery
Volume number 93
Issue number 21
Start page 2015
End page 2021
Total pages 7
Publisher Journal of Bone and Joint Surgery
Place of publication Needham, Mass.
Publication date 2011-11-02
ISSN 0021-9355
1535-1386
Keyword(s) clinical competence
elbow joint
imaging
injury severity score
observer variation
orthopedics
radius fractures
reproducibility of results
x-ray computed tomography
Summary Background: The Broberg and Morrey modification of the Mason classification of radial head fractures has substantial interobserver variation. This study used a large web-based collaborative of experienced orthopaedic surgeons to test the hypothesis that three-dimensional reconstructions of computed tomography (CT) scans improve the interobserver reliability of the classification of radial head fractures according to the Broberg and Morrey modification of the Mason classification.

Methods: Eighty-five orthopaedic surgeons evaluated twelve radial head fractures. They were randomly assigned to review either radiographs and two-dimensional CT scans or radiographs and three-dimensional CT images to determine the fracture classification, fracture characteristics, and treatment recommendations. The kappa multirater measure (κ) was calculated to estimate agreement between observers.

Results: Three-dimensional CT had moderate agreement and two-dimensional CT had fair agreement among observers for the Broberg and Morrey modification of the Mason classification, a difference that was significant. Observers assessed seven fracture characteristics, including fracture line, comminution, articular surface involvement, articular step or gap of ≥2 mm, central impaction, recognition of more than three fracture fragments, and fracture fragments too small to repair. There was a significant difference in kappa values between three-dimensional CT and two-dimensional CT for fracture fragments too small to repair, recognition of three fracture fragments, and central impaction. The difference between the other four fracture characteristics was not significant. Among treatment recommendations, there was fair agreement for both three-dimensional CT and two-dimensional CT.

Conclusions: Although three-dimensional CT led to some small but significant decreases in interobserver variation, there is still considerable disagreement regarding classification and characterization of radial head fractures. Three-dimensional CT may be insufficient to optimize interobserver agreement.
Language eng
DOI 10.2106/JBJS.J.00711
Field of Research 119999 Medical and Health Sciences not elsewhere classified
Socio Economic Objective 970111 Expanding Knowledge in the Medical and Health Sciences
HERDC Research category C1.1 Refereed article in a scholarly journal
Copyright notice ©2011, The Journal of Bone and Joint Surgery
Persistent URL http://hdl.handle.net/10536/DRO/DU:30047653

Document type: Journal Article
Collections: School of Medicine
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.