Motasem Salameh1, Seong-Eun Byun2, Xiangquan Chu3, Michael Hadeed4, August Funk4, Steven Stacey4, Cyril Mauffrey4, Joshua A Parry5. 1. Department of Orthopaedic Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar. 2. Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam, South Korea. 3. Department of Orthopaedic Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan, China. 4. Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver Health, 777 Bannock St, MC 0188, Denver, CO, 80204, USA. 5. Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver Health, 777 Bannock St, MC 0188, Denver, CO, 80204, USA. Joshua.alan.parry@gmail.com.
Abstract
PURPOSE: To determine the interobserver reliability of syndesmosis assessment using intraoperative ankle mortise fluoroscopic images, with and without contralateral images. METHODS: A survey of 19 operative ankle fracture cases was administered to 17 orthopedic surgeons. Respondents were presented with fluoroscopic mortise and stress images of the ankle after fracture fixation and asked if they would fix the syndesmosis. Final fluoroscopic mortise images were then shown, and respondents were asked to assess the reduction of the syndesmosis. Six weeks later, the survey was administered again with the addition of contralateral fluoroscopic ankle mortise images. Responses were compared to a standard response agreed upon by fellowship-trained orthopedic trauma surgeons. RESULTS: Interobserver reliability for syndesmosis fixation and reduction, with and without contralateral images, was considered weak (kappa 0.48 and 0.43; mean difference 0.05, 95% confidence interval (CI) 0.01 to 0.1) and minimal (kappa 0.25 and 0.22; mean difference 0.02, CI - 0.02 to 0.08). With the addition of contralateral mortise images, the number of surgeons who changed their response for syndesmosis fixation and reduction quality ranged from 0% to 41% and 0% to 88%; with the number of responses matching the standard increasing for both fixation (proportional difference (PD) 7%, CI 1% to 14%) and reduction (PD 14%, CI 7% to 21%); CONCLUSIONS: Interobserver reliability of syndesmosis fixation and reduction remained weak to minimal between surgeons, with and without contralateral images. Future studies are necessary to understand the variability in surgeon responses in order to improve the intraoperative assessment and fixation of syndesmotic injuries.
PURPOSE: To determine the interobserver reliability of syndesmosis assessment using intraoperative ankle mortise fluoroscopic images, with and without contralateral images. METHODS: A survey of 19 operative ankle fracture cases was administered to 17 orthopedic surgeons. Respondents were presented with fluoroscopic mortise and stress images of the ankle after fracture fixation and asked if they would fix the syndesmosis. Final fluoroscopic mortise images were then shown, and respondents were asked to assess the reduction of the syndesmosis. Six weeks later, the survey was administered again with the addition of contralateral fluoroscopic ankle mortise images. Responses were compared to a standard response agreed upon by fellowship-trained orthopedic trauma surgeons. RESULTS: Interobserver reliability for syndesmosis fixation and reduction, with and without contralateral images, was considered weak (kappa 0.48 and 0.43; mean difference 0.05, 95% confidence interval (CI) 0.01 to 0.1) and minimal (kappa 0.25 and 0.22; mean difference 0.02, CI - 0.02 to 0.08). With the addition of contralateral mortise images, the number of surgeons who changed their response for syndesmosis fixation and reduction quality ranged from 0% to 41% and 0% to 88%; with the number of responses matching the standard increasing for both fixation (proportional difference (PD) 7%, CI 1% to 14%) and reduction (PD 14%, CI 7% to 21%); CONCLUSIONS: Interobserver reliability of syndesmosis fixation and reduction remained weak to minimal between surgeons, with and without contralateral images. Future studies are necessary to understand the variability in surgeon responses in order to improve the intraoperative assessment and fixation of syndesmotic injuries.
Authors: Scott J Koenig; Paul Tornetta; Gabriel Merlin; Yelena Bogdan; Kenneth A Egol; Robert F Ostrum; Philip R Wolinsky Journal: J Orthop Trauma Date: 2015-09 Impact factor: 2.512
Authors: Michael J Gardner; Demetris Demetrakopoulos; Stephen M Briggs; David L Helfet; Dean G Lorich Journal: Foot Ankle Int Date: 2006-10 Impact factor: 2.827
Authors: Chad P Coles; Paul Tornetta; William T Obremskey; Clay A Spitler; Jaimo Ahn; Gudrun Mirick; Peter Krause; Arvind Nana; Andres Rodriguez-Buitrago Journal: J Orthop Trauma Date: 2019-09 Impact factor: 2.512
Authors: N C Hagemeijer; B Lubberts; J Saengsin; R Bhimani; G Sato; G R Waryasz; G M M J Kerkhoffs; C W DiGiovanni; D Guss Journal: Knee Surg Sports Traumatol Arthrosc Date: 2022-07-26 Impact factor: 4.114