Florian Oehme1,2, Konrad Schütze3, Björn Christian Link4, Herman Frima5, Tim Schepers6, Steven Rhemrev7, Mark Rickman8, Reto Babst4, Frank Joseph Paulus Beeres4. 1. Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, P.O. Box 6000, Spitalstrasse 16, CH-6000, Luzern, Switzerland. FlorianOehme85@gmail.com. 2. Department for Visceral, Thoracic and Vascular surgery, University Hospital Carl Gustav Carus, Dresden, Germany. FlorianOehme85@gmail.com. 3. Department of Trauma Surgery, University Hospital Ulm, P.O. Box 89081, Albert-Einstein-Allee 23, D-89081, Ulm, Germany. 4. Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, P.O. Box 6000, Spitalstrasse 16, CH-6000, Luzern, Switzerland. 5. Department of Surgery, Cantonal Hospital Graubünden, P.O.Box 170, Loëstrasse 170, CH-7000, Chur, Switzerland. 6. Department of Surgery-Traumatology, Amsterdam Medical Centre, Meibergdreef 9, 1105, Amsterdam, AZ, The Netherlands. 7. Department of Surgery, Medical Center Haaglanden, Lijnbaan 32, 2512, The Hague, VA, The Netherlands. 8. Centre for Orthopaedic and Trauma Research, University of Adelaide & Royal Adelaide Hospital, The University of Adelaide, Adelaide, SA, 5005, Australia.
Abstract
PURPOSE: Intraoperative precise visualization of fractures and assessment of the quality of reduction is essential in orthopedic trauma surgery. Fluoroscopic skills will lead to an increased detection rate of minimal abnormalities needing revision intraoperatively. The definition of fluoroscopic skills and the interpretation of acceptable "minimal abnormalities" remains somehow unclear. The purpose of this study was to analyze the subjective quality assessment of intraoperative radiographs (IR) and whether they are influenced by cultural and demographic factors. Furthermore, we aimed to answer the question whether the indication for revision surgery is international comparable or rather influenceable by cultural aspects. METHODS: Intraoperative radiographs of 30 patients operated for an ankle or radius fracture were selected for an international survey. In total, 22 patients were randomly selected from an already existing database and eligible for inclusion if reduction was accomplished during initial operation without planed revision. Eight patients of this group had undergone an unplanned revision surgery (26.6%). Fifteen orthopedic trauma surgeons from three different countries answered this survey. All raters were senior consultants. RESULTS: The quality of reduction was rated as good in both the AP (7.95 of 10) and lateral (7.84 of 10) views. The inter-observer reliability was substantially weaker in Country B (kappa of 0.23) compared to Countries A (p value < 0.05) and C (range 0.33-0.43). In only 33% of the cases the raters requested a postoperative radiograph. This was significantly fewer (p value < 0.001) in Country A. The frequency of postoperative requested CT's was comparable between the countries. CONCLUSION: This study showed acceptable IR assessment in terms of quality rating. Furthermore, it revealed substantial differences in the postoperative decision-making process in different countries, especially regarding the necessity for postoperative radiographs. This suggests that definition for indication of revision surgery is culturally influenced.
PURPOSE: Intraoperative precise visualization of fractures and assessment of the quality of reduction is essential in orthopedic trauma surgery. Fluoroscopic skills will lead to an increased detection rate of minimal abnormalities needing revision intraoperatively. The definition of fluoroscopic skills and the interpretation of acceptable "minimal abnormalities" remains somehow unclear. The purpose of this study was to analyze the subjective quality assessment of intraoperative radiographs (IR) and whether they are influenced by cultural and demographic factors. Furthermore, we aimed to answer the question whether the indication for revision surgery is international comparable or rather influenceable by cultural aspects. METHODS: Intraoperative radiographs of 30 patients operated for an ankle or radius fracture were selected for an international survey. In total, 22 patients were randomly selected from an already existing database and eligible for inclusion if reduction was accomplished during initial operation without planed revision. Eight patients of this group had undergone an unplanned revision surgery (26.6%). Fifteen orthopedic trauma surgeons from three different countries answered this survey. All raters were senior consultants. RESULTS: The quality of reduction was rated as good in both the AP (7.95 of 10) and lateral (7.84 of 10) views. The inter-observer reliability was substantially weaker in Country B (kappa of 0.23) compared to Countries A (p value < 0.05) and C (range 0.33-0.43). In only 33% of the cases the raters requested a postoperative radiograph. This was significantly fewer (p value < 0.001) in Country A. The frequency of postoperative requested CT's was comparable between the countries. CONCLUSION: This study showed acceptable IR assessment in terms of quality rating. Furthermore, it revealed substantial differences in the postoperative decision-making process in different countries, especially regarding the necessity for postoperative radiographs. This suggests that definition for indication of revision surgery is culturally influenced.