Seung Min Ryu1, Jae Woo Park1, Jeong Jae Moon1, Seung Wan Lim1, Moon Soo Kwon1, Oog Jin Shon2. 1. Department of Orthopedic Surgery, Yeungnam University Medical Center, 170 Hyeonchung-ro, Nam-gu, Daegu, 42415, South Korea. 2. Department of Orthopedic Surgery, Yeungnam University Medical Center, 170 Hyeonchung-ro, Nam-gu, Daegu, 42415, South Korea. ossoj@ynu.ac.kr.
Abstract
BACKGROUND: The goal of this study was to compare the inter- and intra-observer reliabilities of computed tomography (CT) scans of bicondylar tibial plateau fractures (Bi-TPFs) with or without distraction with a bridging external fixation (EF) as interpreted by inexperienced surgeons. METHODS: Patients that underwent CT after distraction with a bridging EF were allocated to group 1 (n = 18), and patients that underwent CT before distraction with a bridging EF were allocated to group 2 (n = 18). Five observers were given plain radiographs and CT images to assess (survey 1) and this assessment was repeated six weeks later (survey 2). Agreements regarding fracture classification and pre-operative planning were evaluated using kappa coefficients. In addition, to evaluate fracture severity, we designed a severity score. RESULTS: Inter-observer reliabilities for fracture classification and pre-operative planning were higher in group 1 than in group 2. Surveys 1 and 2 revealed similar kappa coefficients in the two study groups. The mean absolute difference (MAD) in severity scores allocated at the two surveys was significantly different between the two groups (P = 0.045). Intra-observer reliabilities of fracture classification and pre-operative planning were also higher in group 1 than in group 2. In addition, level of training was found to have a significant impact on the MAD in severity scores (P = 0.007). CONCLUSIONS: Inter- and intra-observer reliabilities for fracture classification and pre-operative planning were better for inexperienced surgeons when CT was performed after distraction with a bridging EF for Bi-TPFs. Thus, when staged treatment using EF is selected in Bi-TPF patients, the authors suggest that CT scans be performed after distraction with a bridging EF especially for inexperienced surgeons.
BACKGROUND: The goal of this study was to compare the inter- and intra-observer reliabilities of computed tomography (CT) scans of bicondylar tibial plateau fractures (Bi-TPFs) with or without distraction with a bridging external fixation (EF) as interpreted by inexperienced surgeons. METHODS:Patients that underwent CT after distraction with a bridging EF were allocated to group 1 (n = 18), and patients that underwent CT before distraction with a bridging EF were allocated to group 2 (n = 18). Five observers were given plain radiographs and CT images to assess (survey 1) and this assessment was repeated six weeks later (survey 2). Agreements regarding fracture classification and pre-operative planning were evaluated using kappa coefficients. In addition, to evaluate fracture severity, we designed a severity score. RESULTS: Inter-observer reliabilities for fracture classification and pre-operative planning were higher in group 1 than in group 2. Surveys 1 and 2 revealed similar kappa coefficients in the two study groups. The mean absolute difference (MAD) in severity scores allocated at the two surveys was significantly different between the two groups (P = 0.045). Intra-observer reliabilities of fracture classification and pre-operative planning were also higher in group 1 than in group 2. In addition, level of training was found to have a significant impact on the MAD in severity scores (P = 0.007). CONCLUSIONS: Inter- and intra-observer reliabilities for fracture classification and pre-operative planning were better for inexperienced surgeons when CT was performed after distraction with a bridging EF for Bi-TPFs. Thus, when staged treatment using EF is selected in Bi-TPF patients, the authors suggest that CT scans be performed after distraction with a bridging EF especially for inexperienced surgeons.
Entities:
Keywords:
CT scan; Fracture classification; Tibial plateau fracture; Treatment plan
Authors: Kenneth A Egol; Nirmal C Tejwani; Edward L Capla; Philip L Wolinsky; Kenneth J Koval Journal: J Orthop Trauma Date: 2005-08 Impact factor: 2.512
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