Deakin University
Browse
page-interobserverreliability-2011.pdf (509.61 kB)

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

Download (509.61 kB)
journal contribution
posted on 2011-11-02, 00:00 authored by T Guitton, D Ring, Richard PageRichard Page, Science of Variation Group
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.

History

Journal

Journal of bone and joint surgery

Volume

93

Pagination

2015 - 2021

Location

Needham, Mass.

Open access

  • Yes

ISSN

0021-9355

eISSN

1535-1386

Language

eng

Publication classification

C1.1 Refereed article in a scholarly journal

Copyright notice

2011, The Journal of Bone and Joint Surgery

Editor/Contributor(s)

R Page