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 Wagg; Peter 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; null Rozental; Charles Cassidy; David Kalainov; Eric Hofmeister; Lawrence Weiss; Leon Benson; Taizoon Baxamusa; Doug Hanel; Fabio Suarez; Alberto Castillo; David Miller; Chris 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

doi:10.1007/s11999-014-3592-z

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, Chris 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

Research output: Contribution to journal › Article › peer-review

13 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 language	English
Pages (from-to)	2113-2119
Number of pages	7
Journal	Clinical Orthopaedics and Related Research
Volume	472
Issue number	7
Early online date	8 Apr 2014
DOIs	https://doi.org/10.1007/s11999-014-3592-z
Publication status	Published - Jul 2014
Externally published	Yes

Keywords

Interobserver Agreement
Radial Head
Ligament Injury
Interobserver Reliability
Fracture Fragment

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10.1007/s11999-014-3592-zLicence: In Copyright

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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

@article{a286f08dffeb46f1a15000a9781043dc,

title = "Radiographic loss of contact between radial head fracture fragments is moderately reliable",

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.",

keywords = "Interobserver Agreement, Radial Head, Ligament Injury, Interobserver Reliability, Fracture Fragment",

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

year = "2014",

month = jul,

doi = "10.1007/s11999-014-3592-z",

language = "English",

volume = "472",

pages = "2113--2119",

journal = "Clinical Orthopaedics and Related Research",

issn = "0009-921X",

publisher = "Wolters Kluwer Health",

number = "7",

}

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, Wagg, J, Kloen, P, Grosso, E, Mormino, M, Choudhari, P, Zura, R, Pesantez, R, Thomas, G, Brink, P, Swiontkowski, M, Beingessner, D, Schep, N, Kanakaris, N, Peters, R, Andrew, J, Trenholm, I, Mica, L, Verhofstad, M, Taitsman, L, Hernandez, D, Harris, I, Egol, K, Jeray, K, Borris, L, Barquet, A, Kellam, J, Marsh, J, Hobby, J, Sancheti, P, Guenter, L, DeCoster, T, Crist, B, Della Rocca, G, Merchant, M, Leslie, M, Jenkinson, R, Weiss, D, Rodriguez, E, Stewart, R, Wixted, J, Althausen, P, Schandelmaier, P, Petrisor, B, Andreas, P, Broekhuyse, H, Jones, C, Harvey, E, Rodriguez, F, Kreder, H, Prayson, M, Smith, R, McLaurin, T, Van Vugt, A, Buckley, R, Iyer, V, Baumgaertel, F, Leighton, R, Babst, R, Wang, Q, Yang, E, Hammerberg, E, Elmans, L, Kawaguchi, A, Carmack, D, Basak, A, Kontakis, G, Hall, J, Page, R, Gosens, T, Eygendaal, D, Richardson, M, Wright, T, Dyer, G, Zalavras, C, Walter, F, Duncan, S, Garrigues, G, Rhemrev, S, Wahegaonkar, A, Rosenfeld, J, Spruijt, S, Boyer, M, Jebson, P, De Bedout, R, Bolger, J, Fischer, T, Floyd, W, Adams, J, Sierra, F, Palmer, J, Jacoby, S, Siff, T, Swigart, C, DeSilva, G, Taras, J, Wint, J, Callandruccio, J, Shatford, R, Hutchinson, D, Sasaki, T, Uhl, R, Nolla, J, Kakar, S, Bonatz, E, Papandrea, R, Nancollas, M, Ruggiero, G, Barth, R, Bamberger, B, McAuliffe, J, Richard, M, Baskies, M, Mitchell, S, Polatsch, D, Boretto, J, Lattanza, L, Rozental, Cassidy, C, Kalainov, D, Hofmeister, E, Weiss, L, Benson, L, Baxamusa, T, Hanel, D, Suarez, F, Castillo, A, Miller, D, Wilson, C, Havenhill, T, Grafe, M, Kaplan, S, Spath, C, Walsh, C, Lee, K, Howlett, J, Potter, L, McCulloch, P, Lumsden, B, Meyer, N, Sutker, B, Metzger, C, Ortiz, J, Helgemo, S, Fanuele, J, Pomerance, J, Arnold, B, Hurwit, S, Goslings, J, DeVine, J, Edwards, S, Hughes, T, Abdel-Ghany, M & Kleinlugtenbelt, I 2014, 'Radiographic loss of contact between radial head fracture fragments is moderately reliable', Clinical Orthopaedics and Related Research, vol. 472, no. 7, pp. 2113-2119. https://doi.org/10.1007/s11999-014-3592-z

TY - JOUR

T1 - Radiographic loss of contact between radial head fracture fragments is moderately reliable

AU - Bruinsma, Wendy

AU - Guitton, Thierry

AU - Ring, David

AU - Eng, Kevin

AU - Jokhi, Vispi

AU - Oloruntoba, David

AU - Jain, Sanjev

AU - Melvanki, Parag

AU - Frihagen, Frede

AU - McGraw, Iain

AU - Lenzlinger, Philipp

AU - Ponsen, Kees

AU - Schmidt, Andrew

AU - Ciritsis, Bernhard

AU - Conflitti, Joseph

AU - Turina, Matthias

AU - Poolman, Rudolf

AU - Liem, Ronald

AU - Gulve, R

AU - Wagg, James

AU - Kloen, Peter

AU - Grosso, Elena

AU - Mormino, Matthew

AU - Choudhari, Pradeep

AU - Zura, Robert

AU - Pesantez, Rodrigo

AU - Thomas, George

AU - Brink, Peter

AU - Swiontkowski, Marc

AU - Beingessner, Daphne

AU - Schep, Niels

AU - Kanakaris, Nikolaos

AU - Peters, R

AU - Andrew, John

AU - Trenholm, I

AU - Mica, Ladislav

AU - Verhofstad, Michiel

AU - Taitsman, Lisa

AU - Hernandez, Daniel

AU - Harris, Ian

AU - Egol, Kenneth

AU - Jeray, Kyle

AU - Borris, Lars

AU - Barquet, Antonio

AU - Kellam, James

AU - Marsh, John

AU - Hobby, Jonathan

AU - Sancheti, Parag

AU - Guenter, Lob

AU - DeCoster, Thomas

AU - Crist, Brett

AU - Della Rocca, Gregory

AU - Merchant, Milind

AU - Leslie, Michael

AU - Jenkinson, Richard

AU - Weiss, David

AU - Rodriguez, Edward

AU - Stewart, Rena

AU - Wixted, John

AU - Althausen, Peter

AU - Schandelmaier, Peter

AU - Petrisor, Brad

AU - Andreas, Platz

AU - Broekhuyse, Henry

AU - Jones, Clifford

AU - Harvey, Edward

AU - Rodriguez, Fryda

AU - Kreder, Hans

AU - Prayson, Michael

AU - Smith, Raymond

AU - McLaurin, Toni

AU - Van Vugt, Arie

AU - Buckley, Richard

AU - Iyer, Vishwanath

AU - Baumgaertel, Fred

AU - Leighton, Ross

AU - Babst, Reto

AU - Wang, Qiugen

AU - Yang, Edward

AU - Hammerberg, Eric

AU - Elmans, Leon

AU - Kawaguchi, Alan

AU - Carmack, David

AU - Basak, Amal

AU - Kontakis, George

AU - Hall, Jeremy

AU - Page, Richard

AU - Gosens, Taco

AU - Eygendaal, Denise

AU - Richardson, Martin

AU - Wright, Thomas

AU - Dyer, George

AU - Zalavras, Charalampos

AU - Walter, Frank

AU - Duncan, Scott

AU - Garrigues, Grant

AU - Rhemrev, Steven

AU - Wahegaonkar, Abhijeet

AU - Rosenfeld, Jonathan

AU - Spruijt, Sander

AU - Boyer, Martin

AU - Jebson, Peter

AU - De Bedout, Ramon

AU - Bolger, John

AU - Fischer, Thomas

AU - Floyd, Waldo

AU - Adams, Julie

AU - Sierra, Francisco

AU - Palmer, Jason

AU - Jacoby, Sidney

AU - Siff, Todd

AU - Swigart, Carrie

AU - DeSilva, Gregory

AU - Taras, John

AU - Wint, Jeffrey

AU - Callandruccio, James

AU - Shatford, Russell

AU - Hutchinson, Douglas

AU - Sasaki, Takashi

AU - Uhl, Richard

AU - Nolla, Jose

AU - Kakar, Sanjeev

AU - Bonatz, Ekkehard

AU - Papandrea, Rick

AU - Nancollas, Michael

AU - Ruggiero, Gustavo

AU - Barth, Richard

AU - Bamberger, Brent

AU - McAuliffe, John

AU - Richard, Marc

AU - Baskies, Michael

AU - Mitchell, Scott

AU - Polatsch, Daniel

AU - Boretto, Jorge

AU - Lattanza, Lisa

AU - Rozental, null

AU - Cassidy, Charles

AU - Kalainov, David

AU - Hofmeister, Eric

AU - Weiss, Lawrence

AU - Benson, Leon

AU - Baxamusa, Taizoon

AU - Hanel, Doug

AU - Suarez, Fabio

AU - Castillo, Alberto

AU - Miller, David

AU - Wilson, Chris

AU - Havenhill, Timothy

AU - Grafe, Michael

AU - Kaplan, Saul

AU - Spath, Catherine

AU - Walsh, Christopher

AU - Lee, Kendrick

AU - Howlett, John

AU - Potter, Loren

AU - McCulloch, Patrick

AU - Lumsden, Boyd

AU - Meyer, Nicolas

AU - Sutker, Ben

AU - Metzger, Charles

AU - Ortiz, Jose

AU - Helgemo, Steve

AU - Fanuele, Jason

AU - Pomerance, Jay

AU - Arnold, B

AU - Hurwit, Shep

AU - Goslings, Johan

AU - DeVine, John

AU - Edwards, Scott

AU - Hughes, Thomas

AU - Abdel-Ghany, Mahmoud

AU - Kleinlugtenbelt, I

PY - 2014/7

Y1 - 2014/7

N2 - 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.

AB - 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.

KW - Interobserver Agreement

KW - Radial Head

KW - Ligament Injury

KW - Interobserver Reliability

KW - Fracture Fragment

U2 - 10.1007/s11999-014-3592-z

DO - 10.1007/s11999-014-3592-z

M3 - Article

SN - 0009-921X

VL - 472

SP - 2113

EP - 2119

JO - Clinical Orthopaedics and Related Research

JF - Clinical Orthopaedics and Related Research

IS - 7

ER -

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

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Keywords

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