Journal article
Tibial Plateau Fractures: A New Rank Ordering Method For Determining To What Degree Injury Severity Or Quality Of Reduction Correlate With Clinical Outcome
The Iowa orthopaedic journal, Vol.37, pp.57-63
2017
PMCID: PMC5508287
PMID: 28852336
Appears in Diamond Open Access
Abstract
Injury severity may be the most important factor in determining outcome after articular fractures, but there is a surprising paucity of clinical evidence to support this assertion. The purpose of this study was to utilize a new method for rank ordering a group of patient radiographs to assess the effect of injury severity and quality of reduction on patient outcomes after tibial plateau fractures.
Tibial plateau fractures in 64 patients were treated operatively or non-operatively based on physician preference from standard of care techniques. Fracture severity and reduction quality were stratified from radiographs by four expert clinicians using an iTunes-based rank ordering methodology. The images were distributed electronically, and the ranks were performed on local computers at three different institutions. Clinical outcomes were measured with the SF-12 health questionnaire and the Knee injury and Osteoarthritis Outcome Score (KOOS).
There was excellent or very good agreement between raters for injury severity ranking (correlation 0.77-0.91) and quality of reduction (correlation 0.66-0.82). There was no correlation between the injury severity nor quality of reduction and general or joint-specific clinical outcomes.
Expert orthopaedic traumatologists strongly agree on how to rank order tibial plateau fractures based both on injury severity and quality of reduction. The novel electronic interface utilized allows an ever-expanding series of cases to be ranked quickly, conveniently, and across multiple centers. This interface holds great promise for establishing prospective, continuously expanding rank orders of various fracture types, which may have great value for clinical research, education about fracture severity, and for prognosis and treatment decisions. In the present study, neither injury severity nor quality of reduction correlated with the clinical outcomes. Other patient- and injury-related factors may be more important in determining clinical outcome of tibial plateau fractures than the appearances of the radiographs at the time of injury or after reduction. Level of Evidence: level III evidence.
Details
- Title: Subtitle
- Tibial Plateau Fractures: A New Rank Ordering Method For Determining To What Degree Injury Severity Or Quality Of Reduction Correlate With Clinical Outcome
- Creators
- Katie Freeman - Department of Orthopaedics, The University of MissouriJared L Michalson - Department of Orthopaedics and Rehabilitation, The University of IowaDonald D Anderson - Department of Orthopaedics and Rehabilitation, The University of IowaThomas D Brown - Department of Orthopaedics and Rehabilitation, The University of IowaThomas A DeCoster - Department of Orthopaedics and Rehabilitation, The University of New MexicoDouglas R Dirschl - Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of ChicagoMatthew D Karam - Department of Orthopaedics and Rehabilitation, The University of IowaJ Lawrence Marsh - Department of Orthopaedics and Rehabilitation, The University of Iowa
- Resource Type
- Journal article
- Publication Details
- The Iowa orthopaedic journal, Vol.37, pp.57-63
- Publisher
- Dept. of Orthopaedics, The University of Iowa; United States
- PMID
- 28852336
- PMCID
- PMC5508287
- ISSN
- 1541-5457
- eISSN
- 1555-1377
- Grant note
- P50 AR055533 / NIAMS NIH HHS
- Language
- English
- Date published
- 2017
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Orthopedics and Rehabilitation; Industrial and Systems Engineering
- Record Identifier
- 9984040245002771
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