scholarly journals An Independent Interobserver Reliability and Intraobserver Reproducibility Evaluation of the New Pilon Fracture Classification System Based On CT-Scan

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0037
Author(s):  
Joaquin Palma ◽  
Jorge Filippi Nussbaum ◽  
Pablo Mery ◽  
Mario Abarca ◽  
Andres Mora ◽  
...  
Keyword(s):  
Ct Scan ◽  
Classification System ◽  
Random Sequence ◽  
Classification Systems ◽  
Observer Agreement ◽  
X Rays ◽  
Foot And Ankle ◽  
Fracture Classification ◽  
Pilon Fracture ◽  
Pilon Fractures

Category: Trauma Introduction/Purpose: Objective: To perform an independent inter-observer and intra-observer agreement assessment of the new pilon fracture classification system based on CT-scan. Summary of Background Data: Multiple classification systems have been proposed for pilon fractures, with no consensus to date of which is the most useful tool nor the one that provides the best prognostic orientation. Currently, pilon fractures are classified according to AO and Ruedi Allgower systems based on X-rays. A new pilon fracture classification system based on CT-Scan was recently described by Leonetti and Tigani in 2017. It showed substantial inter- and intra-observer agreement in the study describing it; however, an independent evaluation has not yet been performed, which is required for its wide use in clinical practice and research. Methods: CT-scans of 71 patients with acute traumatic pilon fractures were selected and classified using the morphologic grading of the new pilon fracture classification system by six evaluators (three foot and ankle surgeons and three orthopaedic surgery residents). After a six-week interval, the 71 cases were presented to the same evaluators in a random sequence for repeat evaluation. The Kappa coefficient (k) was used to determine the inter- and intra-observer agreement. Results: The inter-observer agreement was substantial when considering the fracture main types (I, II, III or IV), with k= 0.635 (0.59 - 0.67), but moderate when considering the sub-types (I, IIF, IIS, IIIF, IIIS or IV): k= 0.588 (0.56 - 0.61). The intra-observer agreement was substantial considering the fracture types, with k= 0.65 (0.62 - 0.71) and considering sub-types, k= 0.62 (0.57 - 0.66). No significant differences were observed between foot and ankle surgeons and orthopaedic residents in the overall inter- and intra-observer agreement, or in the inter- and intra-observer agreement of specific I, II, III or IV type of injuries. Conclusion: The new pilon fracture classification system based on CT-scan allows adequate agreement among different observers and by the same observer on separate occasions. Therefore, studies that use this system should be considered reliable. Future prospective studies should determine whether this classification allows surgeons to decide the best treatment for patients with tibial pilon fractures.

FEMORAL NECK FRACTURES AND CLASSIFICATIONS RELIABILITY: ARE WE USING REPRODUCIBLE SYSTEMS?

2021 ◽  
pp. 2150015
Author(s):  
Emilio Enrietti ◽  
Marco Bechis ◽  
Giulia Nicolaci ◽  
Domenico Messina ◽  
Michele Reboli ◽  
...  
Keyword(s):  
Femoral Neck ◽  
High Reliability ◽  
Femoral Neck Fractures ◽  
Classification Systems ◽  
Observer Agreement ◽  
Type I ◽  
X Rays ◽  
Correct Treatment ◽  
Femur Fractures ◽  
Pauwels Classification

Introduction: Classification systems for femoral neck fractures are very helpful for surgeons in order to choose the correct treatment. The purpose of this study was to verify the reliability and reproducibility in the most used classifications for proximal medial femoral fracture: Garden and Pauwels classifications. Materials and methods: Five surgeons independently classified 82 intra-capsular femur fractures treated with 3 cannulated screws using Pauwels and Garden classifications measured on pre- and post-operatively X-Rays. Inter-observer agreement was calculated for both classifications using the multi-rater Fleiss’ kappa; intra-observer agreement from pre-operative to post-operative XRs for Pauwels classification was also calculated with the same method. Results: Only six cases of AVN were registered. The inter-observers agreement based on pre-operative X-rays was moderate for Pauwels classification ([Formula: see text] 0.528) and slightly lower for Garden classification ([Formula: see text] 0.448); but in the simplified Garden classification (type I and II not displaced vs type III and IV displaced) the agreement measured was almost perfect ([Formula: see text] 0.908). The intra-observer agreement for Pauwels classification was moderate ([Formula: see text] 0.456). All the results were statistically significant. Conclusions: This is the first study evaluating the Pauwels angle on both preoperative and postoperative X-rays to assess their reproducibility. Garden classification has a really high reliability and reproducibility in evaluating displaced and not displaced fractures and consequently can be helpful in choosing the correct treatment. Pauwels classification has a lower inter and intra-observer agreement.

scholarly journals Patient Knowledge Regarding Radiation Exposure from Orthopaedic Foot and Ankle Imaging

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0015
Author(s):  
Daniel Bohl ◽  
Blaine Manning ◽  
George Holmes ◽  
Simon Lee ◽  
Johnny Lin ◽  
...  
Keyword(s):  
Ionizing Radiation ◽  
Ct Scan ◽  
Radiation Exposure ◽  
Cone Beam Ct ◽  
Plain Film ◽  
Ct Scans ◽  
Cone Beam ◽  
X Rays ◽  
Foot And Ankle ◽  
X Ray

Category: Other Introduction/Purpose: Foot and ankle surgeons routinely prescribe diagnostic imaging that exposes patients to potentially harmful ionizing radiation. The purpose of this study is to characterize patients’ knowledge regarding radiation exposure associated with common forms of foot and ankle imaging. Methods: A survey was administered to all new patients prior to their first foot and ankle clinic appointments. Patients were asked to compare the amount of harmful radiation associated with chest x-rays to that associated with various types of foot and ankle imaging. Results were tabulated and compared to actual values of radiation exposure from the published literature. Results: A total of 890 patients were invited to participate, of whom 791 (88.9%) completed the survey. The majority of patients believed that a foot x-ray, an ankle x-ray, a “low dose” CT scan of the foot and ankle (alluding to cone-beam CT), and a traditional CT scan of the foot and ankle all contain similar amounts of harmful ionizing radiation to a chest x-ray (Table 1). This is in contrast to the published literature, which suggests that foot x-rays, ankle x-rays, cone beam CT scans of the foot and ankle, and traditional CT scans of the foot and ankle expose patients to 0.006, 0.006, 0.127, and 0.833 chest x-rays worth of radiation. Conclusion: The results of the present study suggest that patients greatly over-estimate the amount of harmful ionizing radiation associated with plain film and cone-beam CT scans of the foot and ankle. Interestingly, their estimates of radiation associated with traditional CT scans of the foot and ankle were relatively accurate. Results suggest that patients may benefit from increased counseling by surgeons regarding the relatively low risk of radiation exposure associated with plain film and cone-beam CT imaging of the foot and ankle.

Patient Knowledge Regarding Radiation Exposure From Foot and Ankle Imaging

2019 ◽  
Vol 13 (4) ◽  
pp. 324-329 ◽  
Author(s):  
Blaine T. Manning ◽  
Daniel D. Bohl ◽  
Alexander J. P. Idarraga ◽  
George B. Holmes ◽  
Simon Lee ◽  
...  
Keyword(s):  
Ionizing Radiation ◽  
Ct Scan ◽  
Radiation Exposure ◽  
Cone Beam Ct ◽  
Private Insurance ◽  
Cone Beam ◽  
X Rays ◽  
Foot And Ankle ◽  
X Ray ◽  
Imaging Results

Foot and ankle surgeons routinely prescribe diagnostic imaging that exposes patients to potentially harmful ionizing radiation. It is unclear how well patients understand the radiation to which they are exposed. In this study, 946 consecutive new patients were surveyed regarding medical imaging and radiation exposure prior to their first appointment. Respondents compared the amount of radiation associated with chest X-rays (CXRs) with various types of foot and ankle imaging. Results were compared with actual values of radiation exposure from the published literature. Of 946 patients surveyed, 841 (88.9%) participated. Most had private insurance (82.8%) and a bachelor’s degree or higher (60.6%). Most believed that foot X-ray, ankle X-ray, “low dose” foot and ankle computed tomography (CT) scan (alluding to cone-beam CT), and traditional foot and ankle CT scan contain similar amounts of ionizing radiation to CXR. This contradicts the published literature that suggests that the actual exposure to patients is 0.006, 0.006, 0.127, and 0.833 CXR equivalents of radiation, respectively. Of patients who had undergone an X-ray, 55.9% thought about the issue of radiation prior to the study, whereas 46.1% of those undergoing a CT scan considered radiation prior to the exam. Similarly, 35.2% and 27.6% reported their doctor having discussed radiation with them prior to obtaining an X-ray and CT scan, respectively. Patients greatly overestimate the radiation exposure associated with plain film X-rays and cone-beam CT scans of the foot and ankle, and may benefit from increased counseling regarding the relatively low radiation exposure associated with these imaging modalities. Level of Evidence: Level III: Prospective questionnaire

A New Classification System for Pilon Fractures Based on CT Scan

2020 ◽  
Vol 28 (5) ◽  
pp. 208-213 ◽  
Author(s):  
Joaquin Palma ◽  
Andres Villa ◽  
Pablo Mery ◽  
Mario Abarca ◽  
Andres Mora ◽  
...  
Keyword(s):  
Ct Scan ◽  
Classification System ◽  
New Classification ◽  
Pilon Fractures

Interobserver and intraobserver variations in tibial pilon fracture classification systems

The Foot ◽  
2010 ◽  
Vol 20 (2-3) ◽  
pp. 61-63 ◽  
Author(s):  
Manjunath Ramappa ◽  
Ali Bajwa ◽  
Anjani Singh ◽  
Paul Mackenney ◽  
Anthony Hui ◽  
...  
Keyword(s):  
Classification Systems ◽  
Fracture Classification ◽  
Pilon Fracture ◽  
Tibial Pilon ◽  
Tibial Pilon Fracture ◽  
Fracture Classification Systems

Interobserver Variation in the AO/OTA Fracture Classification System for Pilon Fractures: Is There a Problem?

1997 ◽  
Vol 11 (7) ◽  
pp. 467-470 ◽  
Author(s):  
M. F. Swiontkowski ◽  
A. K. Sands ◽  
J. Agel ◽  
M. Diab ◽  
J. R. Schwappach ◽  
...  
Keyword(s):  
Classification System ◽  
Interobserver Variation ◽  
Fracture Classification ◽  
Pilon Fractures

scholarly journals Statistical Validation of the Grand Rapids Arch Collapse Classification

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
David Burkard ◽  
Michelle Padley ◽  
John Anderson ◽  
Donald Bohay ◽  
John Maskill ◽  
...  
Keyword(s):  
Classification System ◽  
Weight Bearing ◽  
Critical Role ◽  
Senior Author ◽  
X Rays ◽  
Foot And Ankle ◽  
Statistical Validation ◽  
Kappa Score ◽  
Grand Rapids ◽  
Level Of Agreement

Category: Ankle, Ankle Arthritis, Hindfoot, Midfoot/Forefoot Introduction/Purpose: Over the past decade, gastrocnemius equinus has become increasingly recognized as playing a critical role in multiple foot and ankle pathologies. Arch collapse has been previously described by multiple authors as commonly resulting from gastrocnemius equinus. The Grand Rapids Arch Collapse Classification system was devised in 2011 in order to assist physicians and patients to better understand the mechanism by which arch collapse results, resulting from gastrocnemius equinus. Within this classification system, there are five types or stages described. These are based upon the part of the foot which is affected: gastrocnemius, forefoot, midfoot, hindfoot, ankle, respectively. The purpose of this study was to determine if this classification system is reproducible among physicians by measuring inter-rater and intra-rater reproducibility. Methods: An a priori power analysis determined 50 clinical cases were were required to achieve significant reproducibility among our cohort. From the extensive clinic EMR, a senior author identified a stratified selection of 50 (10 per type) random patients with foot pain and suitable radiographic films from each Grand Rapids classification type. De-identified pre-treatment radiographs and clinical synopses of corresponding patients were provided to ensure clarity, with x-rays, blinded data, and the complete spectrum of cases. All subject x-rays included weight bearing AP, lateral foot and AP, and lateral ankle views. Thirty-three physicians of differing levels of training were sent a test using Qualtrics software with a description of the classification scheme and the 50 cases in a randomized order and analyzed for inter-rater reproducibility. They were then asked to take the same test 8 weeks later to analyze for intra-rater agreement. Results: Of the 33 physicians who received the test, 26 completed the first round (16 attendings, four foot and ankle fellows, and six residents). Kappa coefficient analysis was performed to determine the level of agreement among all subjects. There was substantial agreement among raters in all five types and overall. Kappa scores for each were 0.7164, 0.6510, 0.7219, 0.7013, 0.6291, respectively. The combined Kappa score for all five types was 0.6839, which demonstrates a marked level of agreement. After eight weeks, 13 of the 26 subjects repeated the study which allowed for a calculation of intra-rater reproducibility. A Kappa analysis was once again performed for the 13 subjects that produced a substantial level of agreement with a value of 0.744 for intra-rater reproducibility. Conclusion: The Grand Rapids Arch Collapse Classification system was designed to improve patient satisfaction and provide a mechanism for physicians to easily describe the effects arch collapse. This usefulness of this system is wholly reliant on the repeatability among clinicians. This study has demonstrated that the classification system has substantial reproducibility among

scholarly journals ‘Absolute’ inter-observer classifications agreement for proximal humeral fractures with a single shoulder anteroposterior X-ray

2021 ◽  
Vol 29 (2) ◽  
pp. 230949902110105
Author(s):  
Rocío Martínez-Sola ◽  
Vicente J León-Muñoz ◽  
Antoine Nicolas Najem-Rizk ◽  
Beatriz Soler-Vasco ◽  
Carlos J Arrieta-Martínez ◽  
...  
Keyword(s):  
Classification System ◽  
Classification Systems ◽  
Proximal Humeral Fractures ◽  
Humeral Fractures ◽  
Observer Agreement ◽  
Diagnostic Reliability ◽  
Ao Classification ◽  
X Ray ◽  
Orthopaedic Surgeons ◽  
The Absolute

Purpose: Several studies have been carried out, and there is no classification for proximal humeral fractures (PHF) exempted from variability in interpretation and with questioned reliability. In the present study, we investigated the ‘absolute diagnostic reliability’ of the most currently used classifications for PHFs on a single anterior-posterior X-ray shoulder image. Methods: Six orthopaedic surgeons, with varying levels of experience in shoulder pathology, evaluated radiographs from 30 proximal humeral fractures, according to the ‘absolute reliability’ criteria. Each of the observers rated each fracture according to Neer, Müller/AO and Codman-Hertel’s classification systems. Results: The overall inter-observer agreement (κ) has been 0.297 (CI95% 0.280 to 0.314) for the Neer’s classification system, 0.206 (CI95% 0.193 to 0.218) for the Müller/AO classification system, and 0.315 (CI95% 0.334 to 0.368) for the Codman-Hertel classification system. We found loss of agreement in Neer’s classification as the study progressed, low agreement in the AO classification, and stable values in the different evaluations with the best degree of agreement for Codman-Hertel classification, with a moderate agreement in the second evaluation among the six evaluators. Conclusion: The Neer, AO, and Hertel-Codman classification systems for PHF with a single radiographic projection have a difficult interpretation for orthopaedic surgeons of varying levels of experience, and therefore substantial agreements are not obtained.

Pilon fractures: A new classification system based on CT-scan

Injury ◽  
2017 ◽  
Vol 48 (10) ◽  
pp. 2311-2317 ◽  
Author(s):  
Danilo Leonetti ◽  
Domenico Tigani
Keyword(s):  
Ct Scan ◽  
Classification System ◽  
New Classification ◽  
Pilon Fractures
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