Nils Jan Bleeker1, Megan Cain2, Mariana Rego3, Aimane Saarig4, Andrew Chan5, Inger Sierevelt6, Job N Doornberg7, Ruurd L Jaarsma8. 1. Research Fellow, Department of Orthopaedics and Trauma Surgery, Flinders Medical Centre, Flinders University, Adelaide, Australia. Electronic address: nilsjanbleeker@gmail.com. 2. Flinders Medical Centre, Department of Orthopaedics and Trauma Surgery, Adelaide, Australia. Electronic address: megancain89@gmail.com. 3. Flinders Medical Centre, Flinders University, Adelaide, Australia. Electronic address: mariana.rego@sa.gov.au. 4. Research Fellow, Department of Orthopaedics and Trauma Surgery, Flinders Medical Centre, Flinders University, Adelaide, Australia; Academisch Medisch Centrum Amsterdam, University of Amsterdam, The Netherlands. Electronic address: a.saarig@amc.uva.nl. 5. Flinders Medical Centre, Flinders University, Adelaide, Australia. Electronic address: andrewjcs84@gmail.com. 6. Slotervaart Hospital, Amsterdam, The Netherlands. Electronic address: i.sierevelt@gmail.com. 7. Postdoc Fellow, Deparment of Orthopaedic Surgery, Academisch Medisch Centrum Amsterdam, The Netherlands; Orthopaedic Trauma Fellow, Flinders Medical Centre, Adelaide, Australia; Associate Professor, Flinders University, Adelaide, Australia. Electronic address: doornberg@traumaplatform.org. 8. Consultant Orthopaedic Surgeon, Department of Orthopaedics and Trauma Surgery, Flinders Medical Centre, Adelaide, Australia; Professor of Orthopaedics and Trauma Surgery, Flinders University, Adelaide, Australia. Electronic address: ruurd.jaarsma@sa.gov.au.
Abstract
INTRODUCTION: The purpose of this study is to evaluate the intra- and inter-observer reliability of low-dose protocolled bilateral postoperative Computed Tomography (CT)-assessment of rotational malalignment after intramedullary nailing (IMN) of tibial shaft fractures. MATERIALS AND METHODS: 156 patients were prospectively included with tibial shaft fractures that were treated with IMN in a Level-I Trauma Centre. All patients underwent post-operative bilateral low-dose CT-assessment (effective dose of 0.03784 - 0.05768 mGy) as per hospital protocol. Four observers performed the validated reproducible measurements of tibial torsion in degrees, based on standardized techniques. The Intra-Class Coefficient (ICC) was calculated to evaluate intra- and inter-observer reliability. The intra- and inter-observer reliability was categorized according to Landis and Koch. RESULTS: Intra-observer reliability for quantification of rotational malalignment on post-operative CT after IMN of tibial shaft fractures was excellent with 0.95 (95% CI = 0.92-0.97). The overall inter-observer reliability was 0.90 (95% CI = 0.87-0.92), also excellent according Landis and Koch. CONCLUSION: Firstly, bilateral post-operative low-dose -similar radiation exposure as plain chest radiographs- CT assessment of tibial rotational alignment is a reliable diagnostic imaging modality to assess rotational malalignment in patients following IMN of tibial shaft fractures and it allows for early revision surgery. Secondly, it may contribute to our understanding of the incidence-, predictors- and clinical relevance of post-operative tibial rotational malalignment in patients treated with IMN for a tibial shaft fracture, and facilitates future studies on this topic.
INTRODUCTION: The purpose of this study is to evaluate the intra- and inter-observer reliability of low-dose protocolled bilateral postoperative Computed Tomography (CT)-assessment of rotational malalignment after intramedullary nailing (IMN) of tibial shaft fractures. MATERIALS AND METHODS: 156 patients were prospectively included with tibial shaft fractures that were treated with IMN in a Level-I Trauma Centre. All patients underwent post-operative bilateral low-dose CT-assessment (effective dose of 0.03784 - 0.05768 mGy) as per hospital protocol. Four observers performed the validated reproducible measurements of tibial torsion in degrees, based on standardized techniques. The Intra-Class Coefficient (ICC) was calculated to evaluate intra- and inter-observer reliability. The intra- and inter-observer reliability was categorized according to Landis and Koch. RESULTS: Intra-observer reliability for quantification of rotational malalignment on post-operative CT after IMN of tibial shaft fractures was excellent with 0.95 (95% CI = 0.92-0.97). The overall inter-observer reliability was 0.90 (95% CI = 0.87-0.92), also excellent according Landis and Koch. CONCLUSION: Firstly, bilateral post-operative low-dose -similar radiation exposure as plain chest radiographs- CT assessment of tibial rotational alignment is a reliable diagnostic imaging modality to assess rotational malalignment in patients following IMN of tibial shaft fractures and it allows for early revision surgery. Secondly, it may contribute to our understanding of the incidence-, predictors- and clinical relevance of post-operative tibial rotational malalignment in patients treated with IMN for a tibial shaft fracture, and facilitates future studies on this topic.
Authors: Nils Jan Bleeker; Job N Doornberg; Kaj Ten Duis; Mostafa El Moumni; Inge H F Reininga; Ruurd L Jaarsma; Frank F A IJpma Journal: Eur J Trauma Emerg Surg Date: 2022-07-30 Impact factor: 2.374
Authors: Nils Jan Bleeker; Nicole M van Veelen; Bryan J M van de Wall; Inger N Sierevelt; Björn-Christian Link; Reto Babst; Matthias Knobe; Frank J P Beeres Journal: Eur J Trauma Emerg Surg Date: 2022-01-04 Impact factor: 2.374
Authors: Christian Zeckey; C Neuerburg; Alexander M Keppler; Konstantin Küssner; Eduardo M Suero; Veronika Kronseder; Wolfgang Böcker; Christian Kammerlander Journal: Eur J Trauma Emerg Surg Date: 2021-01-02 Impact factor: 2.374
Authors: Alexander M Keppler; Konstantin Küßner; Anna-Lena Schulze; Eduardo M Suero; Carl Neuerburg; Maximilian Weigert; Christian Braun; Wolfgang Böcker; Christian Kammerlander; Christian Zeckey Journal: BMC Musculoskelet Disord Date: 2021-06-26 Impact factor: 2.362
Authors: Nils Jan Bleeker; Inge H F Reininga; Bryan J M van de Wall; Laurent A M Hendrickx; Frank J P Beeres; Kaj Ten Duis; Job N Doornberg; Ruurd L Jaarsma; Gino M M J Kerkhoffs; Frank F A IJpma Journal: J Orthop Trauma Date: 2021-08-01 Impact factor: 2.512