Journal article
Radiographic fracture assessments : Which ones can we reliably make?
Journal of orthopaedic trauma, Vol.14(6), pp.379-385
2000
DOI: 10.1097/00005131-200008000-00001
PMID: 11001410
Abstract
Objective: To identify the fracture characteristics that can be reliably assessed by analysis of plain radiographs of tibial plateau fractures.
Design: Radiographic review study.
Participants: Five orthopaedic traumatologists served as observers.
Intervention: Observers made assessments based on the radiographs of fifty-six tibial plateau fractures. Precise definitions of the assessments to be made were agreed on by all observers. The tested assessments included raters' abilities to identify and locate fracture lines, identify the presence of fracture displacement and comminution, make quantitative measurements of displacement, and characterize qualitative features of fractures. For thirty-eight of the fractures that had a computed tomography (CT) scan available, assessments were repeated using both radiographs and CT scans.
Main outcome measures: To characterize interobserver reliability, percentage agreement and kappa statistics were calculated for categorical variables, and intraclass correlation coefficients (ICC) were calculated for noncategorical variables.
Results: Reliability of the assessments varied widely. Determining the location of fracture lines had the greatest reliability, whereas the subjective assessments of fracture stability and energy showed the poorest reliability. Although the ICCs for quantitative measurements approached acceptable levels, the tolerance limits were extremely wide. The addition of a CT scan improved the reliability of most assessments, but not to a statistically significant degree.
Conclusions: Many basic radiographic interpretations relied on in making treatment decisions are made variably by observers. Using experienced raters and precise definitions of fracture assessments does not guarantee a high level of agreement. Discrete assessments have higher interrater agreements than do more qualitative assessments. Quantitative measures have wide tolerance limits and, therefore, probably cannot be used reproducibly to classify fractures or make treatment decisions. We conclude the reliability of fracture classification is limited by raters' abilities to agree on basic radiographic assessments.
Details
- Title: Subtitle
- Radiographic fracture assessments : Which ones can we reliably make?
- Creators
- James MARTIN - University of Iowa Hospitals and Clinics, Iowa City, Iowa, United StatesJ. L MARSH - University of Iowa Hospitals and Clinics, Iowa City, Iowa, United StatesJ. V NEPOLA - University of Iowa Hospitals and Clinics, Iowa City, Iowa, United StatesDouglas R DIRSCHL - University of North Carolina, Chapel Hill, North Carolina, United StatesS HURWITZ - University of Virginia, Charlottesville, Virginia, United StatesThomas A DECOSTER - University of New Mexico, Albuquerque, New Mexico, United States
- Resource Type
- Journal article
- Publication Details
- Journal of orthopaedic trauma, Vol.14(6), pp.379-385
- Publisher
- Lippincott Williams & Wilkins; Hagerstown, MD
- DOI
- 10.1097/00005131-200008000-00001
- PMID
- 11001410
- ISSN
- 0890-5339
- eISSN
- 1531-2291
- Language
- English
- Date published
- 2000
- Academic Unit
- Orthopedics and Rehabilitation
- Record Identifier
- 9984040549602771
Metrics
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