Radiographic loss of contact between radial head fracture fragments is moderately reliable

Wendy Bruinsma, Thierry Guitton, David Ring, Kevin Eng, Vispi Jokhi, David Oloruntoba, Sanjev Jain, Parag Melvanki, Frede Frihagen, Iain McGraw, Philipp Lenzlinger, Kees Ponsen, Andrew Schmidt, Bernhard Ciritsis, Joseph Conflitti, Matthias Turina, Rudolf Poolman, Ronald Liem, R Gulve, James WaggPeter Kloen, Elena Grosso, Matthew Mormino, Pradeep Choudhari, Robert Zura, Rodrigo Pesantez, George Thomas, Peter Brink, Marc Swiontkowski, Daphne Beingessner, Niels Schep, Nikolaos Kanakaris, R Peters, John Andrew, I Trenholm, Ladislav Mica, Michiel Verhofstad, Lisa Taitsman, Daniel Hernandez, Ian Harris, Kenneth Egol, Kyle Jeray, Lars Borris, Antonio Barquet, James Kellam, John Marsh, Jonathan Hobby, Parag Sancheti, Lob Guenter, Thomas DeCoster, Brett Crist, Gregory Della Rocca, Milind Merchant, Michael Leslie, Richard Jenkinson, David Weiss, Edward Rodriguez, Rena Stewart, John Wixted, Peter Althausen, Peter Schandelmaier, Brad Petrisor, Platz Andreas, Henry Broekhuyse, Clifford Jones, Edward Harvey, Fryda Rodriguez, Hans Kreder, Michael Prayson, Raymond Smith, Toni McLaurin, Arie Van Vugt, Richard Buckley, Vishwanath Iyer, Fred Baumgaertel, Ross Leighton, Reto Babst, Qiugen Wang, Edward Yang, Eric Hammerberg, Leon Elmans, Alan Kawaguchi, David Carmack, Amal Basak, George Kontakis, Jeremy Hall, Richard Page, Taco Gosens, Denise Eygendaal, Martin Richardson, Thomas Wright, George Dyer, Charalampos Zalavras, Frank Walter, Scott Duncan, Grant Garrigues, Steven Rhemrev, Abhijeet Wahegaonkar, Jonathan Rosenfeld, Sander Spruijt, Martin Boyer, Peter Jebson, Ramon De Bedout, John Bolger, Thomas Fischer, Waldo Floyd, Julie Adams, Francisco Sierra, Jason Palmer, Sidney Jacoby, Todd Siff, Carrie Swigart, Gregory DeSilva, John Taras, Jeffrey Wint, James Callandruccio, Russell Shatford, Douglas Hutchinson, Takashi Sasaki, Richard Uhl, Jose Nolla, Sanjeev Kakar, Ekkehard Bonatz, Rick Papandrea, Michael Nancollas, Gustavo Ruggiero, Richard Barth, Brent Bamberger, John McAuliffe, Marc Richard, Michael Baskies, Scott Mitchell, Daniel Polatsch, Jorge Boretto, Lisa Lattanza, Rozental, Charles Cassidy, David Kalainov, Eric Hofmeister, Lawrence Weiss, Leon Benson, Taizoon Baxamusa, Doug Hanel, Fabio Suarez, Alberto Castillo, David Miller, Christopher Wilson, Timothy Havenhill, Michael Grafe, Saul Kaplan, Catherine Spath, Christopher Walsh, Kendrick Lee, John Howlett, Loren Potter, Patrick McCulloch, Boyd Lumsden, Nicolas Meyer, Ben Sutker, Charles Metzger, Jose Ortiz, Steve Helgemo, Jason Fanuele, Jay Pomerance, B Arnold, Shep Hurwit, Johan Goslings, John DeVine, Scott Edwards, Thomas Hughes, Mahmoud Abdel-Ghany, I Kleinlugtenbelt

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    8 Citations (Scopus)

    Abstract

    Background: Loss of contact between radial head fracture fragments is strongly associated with other elbow or forearm injuries. If this finding has adequate interobserver reliability, it could help examiners identify and treat associated ligament injuries and fractures (eg, forearm interosseous ligament injury or elbow dislocation). Questions/purposes: (1) What is the interobserver agreement on radiographic loss of contact between radial head fracture fragments? (2) Are there factors associated with the observer such as location of practice or subspecialization that increase interobserver reliability? Methods: Fully trained practicing orthopaedic and trauma surgeons from around the world evaluated 27 anteroposterior and lateral radiographs of radial head fractures on a web-based platform for the following characteristics: (1) loss of contact between at least one radial head fracture fragment and the remaining radial head and neck; (2) a gap between fragments of 2 mm or greater; (3) anticipated fracture instability (mobility) on operative exposure; (4) anticipated associated ligament injuries; and (5) recommendation for treatment. Agreement among observers was measured using the multirater kappa measure. Kappas for various observer characteristics were compared using 95% confidence intervals. Results: The overall interobserver agreement was moderate (range, 0.49-0.55) for each question except associated ligament injury, which was fair (0.33). Shoulder and elbow surgeons had substantial agreement (range, 0.51-0.61) in many areas, but kappas were generally in the moderate range (0.41-0.59) based on number of years in practice, radial head fractures treated per year, and trainee supervision. Conclusions: Radiographic signs of radial head fracture instability such as loss of contact have moderate reliability. This characteristic seems clinically useful, because loss of contact between at least one radial head fracture fragment and the remaining radial head and neck is strongly associated with associated ligament injury or other fractures. Level of Evidence: Level III, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

    Original languageEnglish
    Pages (from-to)2113-2119
    Number of pages7
    JournalClinical Orthopaedics and Related Research
    Volume472
    Issue number7
    DOIs
    Publication statusPublished - 2014

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    Bruinsma, W., Guitton, T., Ring, D., Eng, K., Jokhi, V., Oloruntoba, D., Jain, S., Melvanki, P., Frihagen, F., McGraw, I., Lenzlinger, P., Ponsen, K., Schmidt, A., Ciritsis, B., Conflitti, J., Turina, M., Poolman, R., Liem, R., Gulve, R., ... Kleinlugtenbelt, I. (2014). Radiographic loss of contact between radial head fracture fragments is moderately reliable. Clinical Orthopaedics and Related Research, 472(7), 2113-2119. https://doi.org/10.1007/s11999-014-3592-z