Agreement of olecranon fractures before and after the exposure to four classification systems

Benetton, César Augusto Fabris; Cesa, Guilherme; El-Kouba, Gabriel; Ferreira, Ana Paula Bonilauri; Vissoci, João Ricardo Nickenig; Pietrobon, Ricardo

doi:10.1016/j.jse.2014.10.025

Cited by 24 publications

(26 citation statements)

References 18 publications

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“…Therefore it is difficult to draw firm conclusions on the usefulness of this parameter. Overall interobserver agreement for assessment of morphologic features of a middle phalanx base fracture was much greater than other anatomic areas (humerus, elbow, clavicle, and olecranon) [1,2,5,8,10]. We found only fair agreement, indicating variation, regarding specific proposed treatments, which might be a reflection of the lack of high-level evidence and relatively small case series on which surgeons base their decisions [7].…”

Section: Discussionmentioning

confidence: 68%

“…For all cases, the following seven questions were asked in the following order: (1) An invitation to participate was sent to a list of surgeons built as part of the Science Of Variation Group (SOVG) [11,12]. The SOVG consists of 691 orthopaedic, trauma, and plastic surgeons, all with an interest in treating upper extremity conditions.…”

Section: Methodsmentioning

confidence: 99%

“…Putting aside whether the criteria for recommending operative treatment of a proximal interphalangeal joint fracturedislocation are useful and accurate thresholds, if observers cannot agree on the criteria (unreliable) they may not be useful. Studies of fractures at other anatomic sites (such as the humerus, clavicle, and olecranon) showed that some fracture characteristics are assessed more reliably than others [1,2,5,8,10]. In addition to measuring the reliability of radiographic criteria for recommending operative treatment, better understanding of the criteria that have the greatest influence on recommendation for treatment of middle phalanx base fractures would help direct the development of guidelines and measurement techniques for those criteria.…”

Section: Introductionmentioning

confidence: 99%

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What Middle Phalanx Base Fracture Characteristics are Most Reliable and Useful for Surgical Decision-making?

Janssen

Molleman

Guitton

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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BackgroundFracture-dislocations of the proximal interphalangeal joint are vexing because subluxation and articular damage can lead to arthrosis and the treatments are imperfect. Ideally, a surgeon could advise a patient, based on radiographs, when the risk of problems merits operative intervention, but it is unclear if middle phalanx base fracture characteristics are sufficiently reliable to be useful for surgical decision making. Questions/purposesWe evaluated (1) the degree of interobserver agreement as a function of fracture characteristics, (2) the differences in interobserver agreement between experienced and less-experienced hand surgeons, and (3) what fracture characteristics and surgeon characteristics were associated with the decision for operative treatment. Methods Ninety-nine (33%) of 296 hand surgeons evaluated 21 intraarticular middle phalanx base fractures on lateral radiographs. Eighty-one surgeons (82%) were in academic practice and 57 (58%) had less than 10 years experience. Participants assessed six fracture characteristics and recommended treatment (nonoperative or operative: One of the authors (DR) certifies that he, or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount less than USD 10,000 from Wright Medical (Memphis, TN, USA); an amount less than USD 10,000 from Skeletal Dynamics (Miami, FL, USA); an amount less than USD 10,000 from Biomet (Warsaw, IN, USA); an amount less than USD 10,000 from AO North America (Paoli, PA, USA); and an amount less than USD 10,000 from AO International (Dubendorf, Switzerland). All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDAapproval status, of any drug or device prior to clinical use. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. Results With all surgeons pooled together, the interobserver agreement for fracture characteristics was substantial for assessment of a 2-mm articular step or gap (kappa, 0.73; 95% CI, 0.60-0.86; p \ 0.001), subluxation or dislocation (kappa, 0.72; 95% CI, 0.58-0.86; p \ 0.001), and percentage of articular surface involved (intraclass correlation coefficient [ICC], 0.67; 95% CI, 0.54-0.81; p \ 0.001); moderate for comminution (kappa, 0.55; 95% CI, 0.39-0.70; p \ 0.001) and stability (kappa, 0.54; 95% CI, 0.39-0.69; p \ 0.001); and fair for the number of fracture fragments (ICC, 0.39; 95% CI, 0.27-0.57; p \ 0.001). When recommending treatment, interobserver agreement was substantial (kappa, 0.69; 95% CI, 0.50-0.88; p \ 0.001)...

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Section: Discussionmentioning

confidence: 68%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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What Middle Phalanx Base Fracture Characteristics are Most Reliable and Useful for Surgical Decision-making?

Janssen

Molleman

Guitton

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…Two studies of which we are aware have assessed the reproducibility of the Mayo classification in comparison to the Colton, Schatzker, and AO classifications [3,21]. The referenced studies assessed agreement using a k coefficient rather than observed agreement.…”

Section: Validationmentioning

confidence: 99%

“…Interobserver agreement refers to the agreement between different observers and intraobserver agreement is the measure of repeated agreement of the same observer at different time points. These studies showed an interobserver agreement of the Mayo classification system of k = 0.19 [3] and k = 0.32 [19], which represent poor reliability, with interobserver agreement being only marginally greater than chance alone.…”

Section: Validationmentioning

confidence: 99%

Classifications in Brief: Mayo Classification of Olecranon Fractures

Sullivan

Desai

2018

Clin Orthop Relat Res

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Olecranon fractures are relatively common in adults. The various fracture patterns differ in their mechanical characteristics and how they might best be treated surgically [4]. Colton [6] developed a classification system of olecranon fractures in 1973. The Colton classification was based on fracture morphology, mechanism of injury, and stability of the ulnohumeral joint. The AO classification was introduced in 1987 as a systematic way to classify long bone fractures based on location of the fracture line and degree of articular comminution [5, 16]. In this system olecranon fractures were grouped with fractures of the radial head and neck. Cabanela and Morrey [5] first introduced the Mayo classification in 1993 to provide a simplified classification of olecranon fractures based on fracture comminution, displacement, and stability of the ulnohumeral joint.

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Imaging of Elbow Trauma

Beckmann

Brown

2021

Atlas of Emergency Imaging From Head-to-Toe

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Agreement of olecranon fractures before and after the exposure to four classification systems

Cited by 24 publications

References 18 publications

What Middle Phalanx Base Fracture Characteristics are Most Reliable and Useful for Surgical Decision-making?

What Middle Phalanx Base Fracture Characteristics are Most Reliable and Useful for Surgical Decision-making?

Classifications in Brief: Mayo Classification of Olecranon Fractures

Imaging of Elbow Trauma

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