Poor reliability and reproducibility of 3 different radiographical classification systems for distal ulna fractures

Moloney, Maria; Kåredal, Jan; Persson, Tomas; Farnebo, Simon; Adolfsson, Lars

doi:10.2340/17453674.2022.2509

Cited by 3 publications

(1 citation statement)

References 14 publications

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“…The Pipkin and Chiron classifications could classify nearly all fractures and offered outstanding reproducibility with kappa values of about 0.8 (or better). Based on our experience in this study, it seems unlikely that further modifications will improve on this, because adding complexity to fracture classifications is tempting but often makes them less reproducible, rather than more so [7]. We believe the universality and reproducibility we observed for those two classification systems are more than adequate for clinical and research use.…”

Section: Discussionmentioning

confidence: 92%

Clinical Evaluation of Femoral Head Fractures: Which Classification Systems Have the Best Universality, Reliability, and Reproducibility?

Qian

Huang

et al. 2023

Clin Orthop Relat Res

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BackgroundFemoral head fractures are rare but potentially disabling injuries, and classifying them accurately and consistently can help surgeons make good choices about their treatment. However, there is no consensus as to which classification of these fractures is the most advantageous; parameters that might inform this choice include universality (the proportion of fractures that can be classified), as well as, of course, interobserver and intraobserver reproducibility.Questions/purposes(1) Which classification achieves the best universality (defined as the proportion of fractures that can be classified)? (2) Which classification delivers the highest intraobserver and interobserver reproducibility in the clinical CT assessment of femoral head fractures? (3) Based on the answers to those two questions, which classifications are the most applicable for clinical practice and research?MethodsBetween January 2011 and January 2023, 254 patients with femoral head fractures who had CT scans (CT is routine at our institution for patients who have experienced severe hip trauma) were potentially eligible for inclusion in this study, which was performed at a large Level I trauma center in China. Of those, 9% (23 patients) were excluded because of poor-quality CT images, unclosed physes, pathologic fractures, or acetabular dysplasia, leaving 91% (231 patients with 231 hips) for analysis here. Among those, 19% (45) were female. At the time of injury, the mean age was 40 ± 17 years. All fractures were independently classified by four observers according to the Pipkin, Brumback, AO/Orthopaedic Trauma Association (OTA), Chiron, and New classifications. Each observer repeated his classifications again 1 month later to allow us to ascertain intraobserver reliability. To evaluate the universality of classifications, we characterized the percentage of hips that could be classified using the definitions offered in each classification. The kappa (κ) value was calculated to determine interrater and intrarater agreement. We then compared the classifications based on the combination of universality and interobserver and intraobserver reproducibility to determine which classifications might be recommended for clinical and research use.ResultsThe universalities of the classifications were 99% (228 of 231, Pipkin), 43% (99 of 231, Brumback), 94% (216 of 231, AO/OTA), 99% (228 of 231, Chiron), and 100% (231 of 231, New). The interrater agreement was judged as almost perfect (κ 0.81 [95% CI 0.78 to 0.84], Pipkin), moderate (κ 0.51 [95% CI 0.44 to 0.59], Brumback), fair (κ 0.28 [95% CI 0.18 to 0.38], AO/OTA), substantial (κ 0.79 [95% CI 0.76 to 0.82], Chiron), and substantial (κ 0.63 [95% CI 0.58 to 0.68], New). In addition, the intrarater agreement was judged as almost perfect (κ 0.89 [95% CI 0.83 to 0.96]), substantial (κ 0.72 [95% CI 0.69 to 0.75]), moderate (κ 0.51 [95% CI 0.43 to 0.58]), almost perfect (κ 0.87 [95% CI 0.82 to 0.91]), and substantial (κ 0.78 [95% CI 0.59 to 0.97]), respectively. Based on these findings, we determin...

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Section: Discussionmentioning

confidence: 92%

Clinical Evaluation of Femoral Head Fractures: Which Classification Systems Have the Best Universality, Reliability, and Reproducibility?

Qian

Huang

et al. 2023

Clin Orthop Relat Res

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Avaliação da reprodutibilidade e concordância da classificação IDEAL para fraturas de extremidade distal de rádio

Lima,

Silva,

Feitosa

et al. 2024

Rev Bras Ortop (Sao Paulo)

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Resumo Objetivo Analisar a reprodutibilidade e concordância intra- e interobservadores da classificação IDEAL para fraturas de extremidade distal do rádio. Métodos Estudo qualitativo, analítico, realizado pela avaliação de 50 pares de radiografias em duas incidências de pacientes com fratura da extremidade distal do rádio. As radiografias foram avaliadas por dez observadores de diferentes níveis de treinamento em ortopedia em três avaliações distintas. Os resultados foram submetidos aos testes Kappa de Cohen e Fleiss para obtenção dos níveis de concordância intra- e interobservadores. Foram utilizados os programas Excel e SPSS, versão 26.0, para cálculos estatísticos. Resultados Os valores do índice Kappa de Cohen para avaliação intraobservadores indicaram pobre a pouca concordância (-0,177–0,259), com significância estatística em apenas uma instância. Os valores do índice Kappa de Fleiss revelaram pouca concordância entre o grupo de residentes (0,277–0,383) com significância estatística; concordância pobre a pouca entre o grupo de ortopedistas gerais (0,114–0,225) com significância estatística na maioria das instâncias; e concordância moderada entre o grupo de cirurgiões de mão (0,449–0,533) com significância estatística. Conclusão A classificação IDEAL obteve níveis de concordância interobservadores variando entre pobre e moderado, com influência do nível de treinamento dos profissionais. Os outros níveis de concordância intraobservadores variaram de pobre a pouca concordância, mas sem significância estatística.

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Treatment of the Distal Forearm Fracture by Volar Dual Window Approach

Wang,

Chen

2024

Life

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Background: Distal forearm fractures were defined as distal radius fractures with concomitant distal ulna fractures, except ulna styloid fractures. Distal forearm fractures are common among geriatric populations, particularly those with osteoporosis. Conventionally, distal forearm fractures are reduced by a double incision approach; however, malreduction and instability of the distal radioulnar joint were not uncommon. We introduced a modified volar dual window approach to treat the distal forearm fracture and evaluate the functional outcomes and complications. Methods: From January 2020 to June 2023, 13 patients with distal forearm fractures underwent open reduction by the modified dual window approach with locking plate fixation. After surgery, splints were applied for two weeks, and the patients underwent postoperative hand therapy for three months. The mean Quick Disabilities of the Arm, Shoulder, and Hand scores, range of motions, grip strength, postoperative radiographic parameters, and complications data were collected. Results: The mean follow-up period was 12.1 months, and the mean age was 52.3 years. Average wrist flexion was 67°, extension 69°, pronation 81°, and supination 79°. Grip strength was 28.3 ± 11.5 kg, which was 88% of the uninjured opposite side. The Visual Analog Scale score during activities was recorded as 0.5 ± 0.9. The mean Quick Disabilities of the Arm, Shoulder, and Hand score was 14 ± 11.5. The postoperative radiographic parameters were as follows: radial height: 10.8 ± 1.7 mm, radial inclination: 22.6 ± 3.7°, volar tilting: 4.0 ± 3.9°, and ulnar variance: −0.4 ± 1.4 mm. All the patients achieved bone union at the final follow-up. Two patients underwent ulnar implant removal due to irritation symptoms. Neither infection, nor neurovascular injury, nor malreduction developed in these patients. Conclusions: The modified volar dual window approach can achieve good wrist function and distal forearm fracture reduction without increasing neurovascular or wound healing complications. This method is an alternative approach for distal forearm fracture, especially in comminuted distal ulna fracture or distal radioulnar joint incongruity.

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Poor reliability and reproducibility of 3 different radiographical classification systems for distal ulna fractures

Cited by 3 publications

References 14 publications

Clinical Evaluation of Femoral Head Fractures: Which Classification Systems Have the Best Universality, Reliability, and Reproducibility?

Clinical Evaluation of Femoral Head Fractures: Which Classification Systems Have the Best Universality, Reliability, and Reproducibility?

Avaliação da reprodutibilidade e concordância da classificação IDEAL para fraturas de extremidade distal de rádio

Treatment of the Distal Forearm Fracture by Volar Dual Window Approach

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