Interobserver reliability of radial head fracture classification: two-dimensional compared with three-dimensional CT.
Earp BE, Ladd AL, Evans PJ, Kuo CE, Biert J, van Dijk CN, Dantuluri PK, Ruchelsman DE, Ponsen KJ, Soong M, Davis T, Shyam AK, Phieffer LS, LeCroy CM, Richardson M, Schmidt AH, Jebson PL, Levin PE, Della Rocca GJ, Goldfarb CA, Jeray KJ, Kalainov DM, Dyer GS, Chen NT, Osterman AL, Athwal GS, Leenen LP, Wright TW, Swiontkowski MF, Slutsky DJ, Frihagen F, Duncan SF, Papandrea RF, Chung KC, Blazar P, Feibel RJ, Zura RD, van der Heide HJ, Tashjian RZ, Elmans L, Jiuliano JA, Rizzo M, Sodha S, McAuliffe JA, Culp RW, Orbay J, Cassidy C, Albers RG, Katolik LI, Abrams RA, Baratz ME, Egol KA, Conflitti JM, Hanel DP, Nolla JM, Hausman M, Caputo AE, Poolman RW, Axelrod TS, McKee MD, Goslings JC, Sancheti PK, Brink PR, Swigart CR, Hughes TB, Segalman KA, van Eerten PV, Crist BD, Diao E, Page RS, Lattanza LL, Thomas G, Fanuele JC, Kloen P, Gosens T, Zalavras C, Taras JS, Greenberg JA, Hammerberg EM, Catalano LW 3rd, Pesantez RF, van Vugt AB, Kronlage SC, Baskies MA, Boyer MI, Giannoudis PV, Prayson MJ, Grosso E.
Source
Massachusetts General Hospital, Boston, Massachusetts, USA.
Abstract
BACKGROUND:
The Broberg and Morrey modification of the Mason classification of radial head fractures has substantial interobserver variation. This study used a large web-based collaborative of experienced orthopaedic surgeons to test the hypothesis that three-dimensional reconstructions of computed tomography (CT) scans improve the interobserver reliability of the classification of radial head fractures according to the Broberg and Morrey modification of the Mason classification.
METHODS:
Eighty-five orthopaedic surgeons evaluated twelve radial head fractures. They were randomly assigned to review either radiographs and two-dimensional CT scans or radiographs and three-dimensional CT images to determine the fracture classification, fracture characteristics, and treatment recommendations. The kappa multirater measure (κ) was calculated to estimate agreement between observers.
RESULTS:
Three-dimensional CT had moderate agreement and two-dimensional CT had fair agreement among observers for the Broberg and Morrey modification of the Mason classification, a difference that was significant. Observers assessed seven fracture characteristics, including fracture line, comminution, articular surface involvement, articular step or gap of ≥2 mm, central impaction, recognition of more than three fracture fragments, and fracture fragments too small to repair. There was a significant difference in kappa values between three-dimensional CT and two-dimensional CT for fracture fragments too small to repair, recognition of three fracture fragments, and central impaction. The difference between the other four fracture characteristics was not significant. Among treatment recommendations, there was fair agreement for both three-dimensional CT and two-dimensional CT.
CONCLUSIONS:
Although three-dimensional CT led to some small but significant decreases in interobserver variation, there is still considerable disagreement regarding classification and characterization of radial head fractures. Three-dimensional CT may be insufficient to optimize interobserver agreement.
- PMID:
- 22048097
- [PubMed - indexed for MEDLINE]
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