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Radiographic loss of contact between radial head fracture fragments is moderately reliable

Bruinsma, Wendy E., Guitton, Thierry, Ring, David, Eng, Kevin, Page, Richard S. and Science of Variation Group 2014, Radiographic loss of contact between radial head fracture fragments is moderately reliable, Clinical orthopaedics and related research ®, vol. 472, no. 7, pp. 2113-2119, doi: 10.1007/s11999-014-3592-z.

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Title Radiographic loss of contact between radial head fracture fragments is moderately reliable
Author(s) Bruinsma, Wendy E.
Guitton, Thierry
Ring, David
Eng, Kevin
Page, Richard S.
Science of Variation Group
Journal name Clinical orthopaedics and related research ®
Volume number 472
Issue number 7
Start page 2113
End page 2119
Total pages 7
Publisher Springer
Place of publication New York, N.Y.
Publication date 2014-07
ISSN 0009-921X
1528-1132
Keyword(s) Clinical Competence
Elbow Joint
Female
Humans
Joint Instability
Male
Observer Variation
Predictive Value of Tests
Prognosis
Radiography
Radius
Radius Fractures
Reproducibility of Results
Specialization
Science of Variation Group
Summary BACKGROUND: Loss of contact between radial head fracture fragments is strongly associated with other elbow or forearm injuries. If this finding has adequate interobserver reliability, it could help examiners identify and treat associated ligament injuries and fractures (eg, forearm interosseous ligament injury or elbow dislocation).
QUESTIONS/PURPOSES: (1) What is the interobserver agreement on radiographic loss of contact between radial head fracture fragments? (2) Are there factors associated with the observer such as location of practice or subspecialization that increase interobserver reliability?
METHODS: Fully trained practicing orthopaedic and trauma surgeons from around the world evaluated 27 anteroposterior and lateral radiographs of radial head fractures on a web-based platform for the following characteristics: (1) loss of contact between at least one radial head fracture fragment and the remaining radial head and neck; (2) a gap between fragments of 2 mm or greater; (3) anticipated fracture instability (mobility) on operative exposure; (4) anticipated associated ligament injuries; and (5) recommendation for treatment. Agreement among observers was measured using the multirater kappa measure. Kappas for various observer characteristics were compared using 95% confidence intervals.
RESULTS: The overall interobserver agreement was moderate (range, 0.49-0.55) for each question except associated ligament injury, which was fair (0.33). Shoulder and elbow surgeons had substantial agreement (range, 0.51-0.61) in many areas, but kappas were generally in the moderate range (0.41-0.59) based on number of years in practice, radial head fractures treated per year, and trainee supervision.
CONCLUSIONS: Radiographic signs of radial head fracture instability such as loss of contact have moderate reliability. This characteristic seems clinically useful, because loss of contact between at least one radial head fracture fragment and the remaining radial head and neck is strongly associated with associated ligament injury or other fractures.
LEVEL OF EVIDENCE: Level III, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.
Language eng
DOI 10.1007/s11999-014-3592-z
Field of Research 119999 Medical and Health Sciences not elsewhere classified
1103 Clinical Sciences
Socio Economic Objective 929999 Health not elsewhere classified
HERDC Research category C1.1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2014, The Association of Bone and Joint Surgeons
Persistent URL http://hdl.handle.net/10536/DRO/DU:30087936

Document type: Journal Article
Collection: School of Medicine
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