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

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

Research output: Contribution to journalArticle

8 Scopus citations

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 languageEnglish (US)
Pages (from-to)2113-2119
Number of pages7
JournalClinical Orthopaedics and Related Research
Volume472
Issue number7
DOIs
StatePublished - Jul 2014

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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