Intra- and interobserver agreement on the Oestern and Tscherne classification of soft tissue injury in periarticular lower-limb closed fractures

Valderrama-Molina, Carlos Oliver; Estrada-Castrillón, Mauricio; Hincapie, Jorge Andrés; Lugo-Agudelo, Luz Helena

doi:10.25100/cm.v45i4.1476

Cited by 22 publications

(13 citation statements)

References 20 publications

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“…Although some researchers found a certain correlation between the Tscherne soft tissue injury classi cation and postoperative complications [23], our results indicated that the severity of soft tissue injury was not associated with pin insertion complications. It is worth noting that, in all our patients, the pin was placed far from the site of injury.…”

Section: Discussioncontrasting

confidence: 79%

Early complications of preoperative external traction fixation in staged treatment of tibial fractures: a 402 cases series study

Yang¹,

Zhu

Dong³

2020

Preprint

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Background and Objective: Different external skeletal fixators have been widely used in preoperative traction of high-energy tibial fractures prior to a definitive surgical treatment. However, early complications associated with this staged treatment for traction and soft tissue injury recovery have rarely been discussed. This study aimed to analyze the early complications associated with preoperative external traction fixation in the staged treatment of tibial fractures.Materials and Methods: A total of 402 patients with high-energy tibial fractures treated using preoperative external traction fixation at a level-1 trauma center from 2014 to 2018 were enrolled in this retrospective study. Data regarding the demographic information, Tscherne soft tissue injury, fracture site, entry point placement, and duration of traction were recorded. Procedure-related complications such as movement and sensation disorder, vessel injury, discharge, infection, loosening, and iatrogenic fracture were analyzed.Results: The mean patient age was 42.5 (18–71) years and the mean duration of traction was 7.5 (0–26) days. In total, 19 (4.7%) patients presented with procedure-related complications, including technique-associated complications in 6 patients and nursing-associated complications in 13. Differences in the incidence of complications with respect to sex, affected side, soft tissue injury classification, and fracture sites were not observed. However, the number of complications due to hammer insertions was significantly fewer than those due to drill insertions (2.9% vs. 7.4%).Conclusion: The application of preoperative external traction fixation had been proved to be an ideal alternative treatment for high energy tibial fractures. In this study, we found the incidence of early complications of the fixation is low, and it is not significantly associated with the severity of soft tissue injury and fracture site. Although relatively rough and more likely to cause pain, complications of hammer insertions were significantly fewer than drill insertions. The possible reason was higher probability of heat damage and loosening by drilling.

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Section: Discussioncontrasting

confidence: 79%

Early complications of preoperative external traction fixation in staged treatment of tibial fractures: a 402 cases series study

Yang¹,

Zhu

Dong³

2020

Preprint

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“…The number of radiographs and observers in this study is therefore within the norms found in the literature. 6 , 13 , 14 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 …”

Section: Discussionmentioning

confidence: 99%

Evaluation of interobserver agreement in Albertoni's classification for mallet finger

Almeida

Fernandes

Santos

et al. 2018

Revista Brasileira de Ortopedia (English Edition)

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ObjectiveTo measure the reliability of Albertoni's classification for mallet finger.MethodsAgreement study. Forty-three radiographs of patients with mallet finger were assessed by 19 responders (12 hand surgeons and seven residents). Injuries were classified by Albertoni's classification. For agreement comparison, lesions were grouped as: (A) tendon avulsion; (B) avulsion fracture; (C) fracture of the dorsal lip; and (D) physis injury–and subgroups (each group divided into two subgroups). Agreement was assessed by Fleiss's modification for kappa statistics.ResultsAgreement was excellent for Group A (k = 0.95 (0.93–0.97)) and remained good when separated into A1 and A2. Group B was moderate (k = 0.42 (0.39–0.44)) and poor when separated into B1 and B2. In the Group C, agreement was good (k = 0.72 (0.70–0.74)), but when separated into C1 and C2, it became moderate. Group D was always poor (k = 0.16 (0.14–0.19)). The general agreement was moderate, with (k = 0.57 (0.56–0.58)).ConclusionAlbertoni's classification evaluated for interobserver agreement is considered a reproducible classification by the method used in the research.

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“…Numerous retrospective studies comparing outcomes of ORIF and EFLIF in high-energy fractures have been conducted. 1,12,15,16 Nonetheless in interpreting the data from registrybased and institutional series, the shortcomings of retrospective analyses must be considered. These shortcomings include patient, surgeon and treatment selection biases.…”

Section: Discussionmentioning

confidence: 99%

“…11 The classification has demonstrated an adequate level of intraobserver and interobserver agreement in tibial plateau and tibial pilon fractures. 12 Surgical interventions were performed by a single surgeon, the first author. ORIF was performed through a medial approach, with interfragmentary screws and application of a distal tibial anatomical neutralisation plates.…”

Section: Surgical Interventionsmentioning

confidence: 99%

Open Reduction Internal Fixation versus External Fixation with Limited Internal Fixation for Displaced Comminuted Closed Pilon Fractures: A Randomised Prospective Study

Kotb

El-Hussein

Samir

et al. 2018

Journal of Orthopaedics, Trauma and Rehabilitation

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Background: Pilon fractures involve the dome of the distal tibial articular surface. The optimal treatment for high-energy pilon fractures remains controversial. Some authors advocate the use of open reduction and internal fixation (ORIF) to avoid articular incongruence. Others advocate the use of bridging external fixation with limited internal fixation (EFLIF) to reduce soft tissue complications. Literature reports of prospective studies comparing the radioclinical outcomes of ORIF and EFLIF in high-energy fractures are scarce. Retrospective studies have their limitations because of insufficient randomisation. The objective of this randomised prospective study is to compare the clinical, radiologic and functional outcomes of displaced and comminuted closed pilon fractures, Rüedi and Allg€ ower type II and III, treated by either ORIF or EFLIF. Materials and methods: Forty-two patients were selected for the study. Twenty-two patients were subjected to ORIF and 20 patients were subjected to EFLIF. We used the American Orthopaedic Foot and Ankle Society score as a standard method of reporting clinical status of the ankle. Patients were followedup clinically and radiologically for over 2 years after the surgical treatment. Results: The results of ORIF and EFLIF in treatment of high-energy pilon fractures are equally effective in terms of functional outcomes and complication rates on the short term. Conclusion: Soft tissue integrity and fracture comminution seem to have a significant influence on outcomes of intervention. A prospective multicentre study with a larger sample size that controls for other associated variables and comorbidities is warranted. Level of evidence: Level II.

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Intra- and interobserver agreement on the Oestern and Tscherne classification of soft tissue injury in periarticular lower-limb closed fractures

Cited by 22 publications

References 20 publications

Early complications of preoperative external traction fixation in staged treatment of tibial fractures: a 402 cases series study

Early complications of preoperative external traction fixation in staged treatment of tibial fractures: a 402 cases series study

Evaluation of interobserver agreement in Albertoni's classification for mallet finger

Open Reduction Internal Fixation versus External Fixation with Limited Internal Fixation for Displaced Comminuted Closed Pilon Fractures: A Randomised Prospective Study

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