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 Wagg; Peter Kloen; Elena Grosso; Matt 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

doi:10.1007/s11999-014-3592-z

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, Matt 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

Orthopedic Surgery

Research output: Contribution to journal › Article › peer-review

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 language	English (US)
Pages (from-to)	2113-2119
Number of pages	7
Journal	Clinical orthopaedics and related research
Volume	472
Issue number	7
DOIs	https://doi.org/10.1007/s11999-014-3592-z
State	Published - Jul 2014

ASJC Scopus subject areas

Surgery
Orthopedics and Sports Medicine

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10.1007/s11999-014-3592-z

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Bruinsma, W. E., Guitton, T., Ring, D., Eng, K., Jokhi, V., Oloruntoba, D. O., Jain, S., Melvanki, P., Frihagen, F., McGraw, I., Lenzlinger, P., Ponsen, K. J., Schmidt, A., Ciritsis, B., Conflitti, J. M., Turina, M., Poolman, R. W., Liem, R., Gulve, R. S., ... Kleinlugtenbelt, I. J. V. (2014). Radiographic loss of contact between radial head fracture fragments is moderately reliable. Clinical orthopaedics and related research, 472(7), 2113-2119. https://doi.org/10.1007/s11999-014-3592-z

Bruinsma, WE, Guitton, T, Ring, D, Eng, K, Jokhi, V, Oloruntoba, DO, Jain, S, Melvanki, P, Frihagen, F, McGraw, I, Lenzlinger, P, Ponsen, KJ, Schmidt, A, Ciritsis, B, Conflitti, JM, Turina, M, Poolman, RW, Liem, R, Gulve, RS, Wagg, J, Kloen, P, Grosso, E, Mormino, M, Choudhari, P, Zura, RD, Pesantez, R, Thomas, G, Brink, P, Swiontkowski, M, Beingessner, D, Schep, N, Kanakaris, N, Peters, RW, Andrew, J, Trenholm, I, Mica, L, Verhofstad, MHJ, Taitsman, L, Hernandez, D, Harris, I, Egol, K, Jeray, K, Borris, LC, Barquet, A, Kellam, J, Marsh, JL, Hobby, JL, Sancheti, P, Guenter, L, DeCoster, T, Crist, BD, Della Rocca, GJ, Merchant, M, Leslie, MP, Jenkinson, R, Weiss, D, Rodriguez, EK, Stewart, R, Wixted, J, Althausen, P, Schandelmaier, P, Petrisor, B, Andreas, P, Broekhuyse, H, Jones, C, Harvey, E, Rodríguez, FM, Kreder, HJ, Prayson, M, Smith, RM, McLaurin, TM, Van Vugt, AB, Buckley, R, Iyer, VM, Baumgaertel, F, Leighton, R, Babst, RH, Wang, Q, Yang, E, Hammerberg, EM, Elmans, L, Kawaguchi, A, Carmack, DB, Basak, A, Kontakis, G, Hall, J, Page, RS, Gosens, T, Eygendaal, D, Richardson, M, Wright, T, Dyer, GSM, Zalavras, C, Walter, F, Duncan, S, Garrigues, G, Rhemrev, S, Wahegaonkar, AL, Rosenfeld, J, Spruijt, S, Boyer, M, Jebson, P, De Bedout, R, Bolger, JT, Fischer, TJ, Floyd, WE, Adams, J, Sierra, FJA, Jason Palmer, M, Jacoby, S, Siff, T, Swigart, C, DeSilva, G, Taras, J, Wint, J, Calandruccio, J, Shatford, R, Hutchinson, DT, Sasaki, T, Uhl, R, Nolla, J, Kakar, S, Bonatz, E, Papandrea, R, Nancollas, M, Ruggiero, GM, Barth, R, Bamberger, B, McAuliffe, J, Richard, MJ, Baskies, M, Mitchell, S, Polatsch, D, Boretto, J, Lattanza, L, Rozental, Cassidy, C, Kalainov, DM, Hofmeister, E, Weiss, L, Benson, L, Baxamusa, T, Hanel, D, Suarez, F, Castillo, AP, Miller, DR, Wilson, C, Havenhill, TG, Grafe, MW, Kaplan, S, Spath, C, Walsh, CJ, Lee, K, Howlett, J, Potter, L, McCulloch, PT, Lumsden, B, Meyer, N, Sutker, B, Metzger, C, Ortiz, JA, Helgemo, S, Fanuele, J, Pomerance, J, Arnnold Batson, W, Hurwit, S, Goslings, JC, DeVine, JG, Edwards, S, Hughes, T, Abdel-Ghany, MI & Kleinlugtenbelt, IJV 2014, 'Radiographic loss of contact between radial head fracture fragments is moderately reliable', Clinical orthopaedics and related research, vol. 472, no. 7, pp. 2113-2119. https://doi.org/10.1007/s11999-014-3592-z

@article{a62616b1e6bf4d75aad41a41cdc21ab4,

title = "Radiographic loss of contact between radial head fracture fragments is moderately reliable",

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.",

author = "Bruinsma, {Wendy E.} and Thierry Guitton and David Ring and Kevin Eng and Vispi Jokhi and Oloruntoba, {David O.} and Sanjev Jain and Parag Melvanki and Frede Frihagen and Iain McGraw and Philipp Lenzlinger and Ponsen, {K. J.} and Andrew Schmidt and Bernhard Ciritsis and Conflitti, {Joseph M.} and Matthias Turina and Poolman, {Rudolf W.} and Ronald Liem and Gulve, {R. S.} and James Wagg and Peter Kloen and Elena Grosso and Matt Mormino and Pradeep Choudhari and Zura, {Robert D.} and Rodrigo Pesantez and George Thomas and Peter Brink and Marc Swiontkowski and Daphne Beingessner and Niels Schep and Nikolaos Kanakaris and Peters, {R. W.} and J. Andrew and I. Trenholm and Ladislav Mica and Verhofstad, {M. H.J.} and Lisa Taitsman and Daniel Hernandez and Ian Harris and Kenneth Egol and Kyle Jeray and Borris, {Lars C.} and Antonio Barquet and James Kellam and Marsh, {John L.} and Hobby, {Jonathan L.} and Parag Sancheti and Lob Guenter and Thomas DeCoster and Crist, {Brett D.} and {Della Rocca}, {Gregory J.} and Milind Merchant and Leslie, {Michael P.} and Richard Jenkinson and David Weiss and Rodriguez, {Edward K.} and Rena Stewart and John Wixted and Peter Althausen and Peter Schandelmaier and Brad Petrisor and Platz Andreas and Henry Broekhuyse and Clifford Jones and Edward Harvey and Rodr{\'i}guez, {Fryda Medina} and Kreder, {Hans J.} and Michael Prayson and Smith, {Raymond Malcolm} and McLaurin, {Toni M.} and {Van Vugt}, {Arie B.} and Richard Buckley and Iyer, {Vishwanath M.} and Fred Baumgaertel and Ross Leighton and Babst, {Reto H.} and Qiugen Wang and Edward Yang and Hammerberg, {Eric Mark} and Leon Elmans and Alan Kawaguchi and Carmack, {David B.} and Amal Basak and George Kontakis and Jeremy Hall and Page, {Richard S.} and Taco Gosens and Denise Eygendaal and Martin Richardson and Thomas Wright and Dyer, {George S.M.} and Charalampos Zalavras and Frank Walter and Scott Duncan and Grant Garrigues and Steven Rhemrev and Wahegaonkar, {Abhijeet L.} and Jonathan Rosenfeld and Sander Spruijt and Martin Boyer and Peter Jebson and {De Bedout}, Ramon and Bolger, {John T.} and Fischer, {Thomas J.} and Floyd, {Waldo E.} and Julie Adams and Sierra, {Francisco Javier Aguilar} and {Jason Palmer}, M. and Sidney Jacoby and Todd Siff and Carrie Swigart and Gregory DeSilva and John Taras and Jeffrey Wint and Jim Calandruccio and Russell Shatford and Hutchinson, {Douglas T.} and Takashi Sasaki and Richard Uhl and Jose Nolla and Sanjeev Kakar and Ekkehard Bonatz and Rick Papandrea and Michael Nancollas and Ruggiero, {Gustavo Mantovani} and Richard Barth and Brent Bamberger and John McAuliffe and Richard, {Marc J.} and Michael Baskies and Scott Mitchell and Daniel Polatsch and Jorge Boretto and Lisa Lattanza and Rozental and Charles Cassidy and Kalainov, {David M.} and Eric Hofmeister and Lawrence Weiss and Leon Benson and Taizoon Baxamusa and Doug Hanel and Fabio Suarez and Castillo, {Alberto P{\'e}rez} and Miller, {David R.} and Chris Wilson and Havenhill, {Timothy G.} and Grafe, {Michael W.} and Saul Kaplan and Catherine Spath and Walsh, {Christopher J.} and Kendrick Lee and John Howlett and Loren Potter and McCulloch, {Patrick T.} and Boyd Lumsden and Nick Meyer and Ben Sutker and Charles Metzger and Ortiz, {Jose A.} and Steve Helgemo and Jason Fanuele and Jay Pomerance and {Arnnold Batson}, W. and Shep Hurwit and Goslings, {J. C.} and DeVine, {John G.} and Scott Edwards and Thomas Hughes and Abdel-Ghany, {Mahmoud I.} and Kleinlugtenbelt, {I. J.V.}",

year = "2014",

month = jul,

doi = "10.1007/s11999-014-3592-z",

language = "English (US)",

volume = "472",

pages = "2113--2119",

journal = "Clinical orthopaedics and related research",

issn = "0009-921X",

publisher = "Springer New York",

number = "7",

}

TY - JOUR

T1 - Radiographic loss of contact between radial head fracture fragments is moderately reliable

AU - Bruinsma, Wendy E.

AU - Guitton, Thierry

AU - Ring, David

AU - Eng, Kevin

AU - Jokhi, Vispi

AU - Oloruntoba, David O.

AU - Jain, Sanjev

AU - Melvanki, Parag

AU - Frihagen, Frede

AU - McGraw, Iain

AU - Lenzlinger, Philipp

AU - Ponsen, K. J.

AU - Schmidt, Andrew

AU - Ciritsis, Bernhard

AU - Conflitti, Joseph M.

AU - Turina, Matthias

AU - Poolman, Rudolf W.

AU - Liem, Ronald

AU - Gulve, R. S.

AU - Wagg, James

AU - Kloen, Peter

AU - Grosso, Elena

AU - Mormino, Matt

AU - Choudhari, Pradeep

AU - Zura, Robert D.

AU - Pesantez, Rodrigo

AU - Thomas, George

AU - Brink, Peter

AU - Swiontkowski, Marc

AU - Beingessner, Daphne

AU - Schep, Niels

AU - Kanakaris, Nikolaos

AU - Peters, R. W.

AU - Andrew, J.

AU - Trenholm, I.

AU - Mica, Ladislav

AU - Verhofstad, M. H.J.

AU - Taitsman, Lisa

AU - Hernandez, Daniel

AU - Harris, Ian

AU - Egol, Kenneth

AU - Jeray, Kyle

AU - Borris, Lars C.

AU - Barquet, Antonio

AU - Kellam, James

AU - Marsh, John L.

AU - Hobby, Jonathan L.

AU - Sancheti, Parag

AU - Guenter, Lob

AU - DeCoster, Thomas

AU - Crist, Brett D.

AU - Della Rocca, Gregory J.

AU - Merchant, Milind

AU - Leslie, Michael P.

AU - Jenkinson, Richard

AU - Weiss, David

AU - Rodriguez, Edward K.

AU - Stewart, Rena

AU - Wixted, John

AU - Althausen, Peter

AU - Schandelmaier, Peter

AU - Petrisor, Brad

AU - Andreas, Platz

AU - Broekhuyse, Henry

AU - Jones, Clifford

AU - Harvey, Edward

AU - Rodríguez, Fryda Medina

AU - Kreder, Hans J.

AU - Prayson, Michael

AU - Smith, Raymond Malcolm

AU - McLaurin, Toni M.

AU - Van Vugt, Arie B.

AU - Buckley, Richard

AU - Iyer, Vishwanath M.

AU - Baumgaertel, Fred

AU - Leighton, Ross

AU - Babst, Reto H.

AU - Wang, Qiugen

AU - Yang, Edward

AU - Hammerberg, Eric Mark

AU - Elmans, Leon

AU - Kawaguchi, Alan

AU - Carmack, David B.

AU - Basak, Amal

AU - Kontakis, George

AU - Hall, Jeremy

AU - Page, Richard S.

AU - Gosens, Taco

AU - Eygendaal, Denise

AU - Richardson, Martin

AU - Wright, Thomas

AU - Dyer, George S.M.

AU - Zalavras, Charalampos

AU - Walter, Frank

AU - Duncan, Scott

AU - Garrigues, Grant

AU - Rhemrev, Steven

AU - Wahegaonkar, Abhijeet L.

AU - Rosenfeld, Jonathan

AU - Spruijt, Sander

AU - Boyer, Martin

AU - Jebson, Peter

AU - De Bedout, Ramon

AU - Bolger, John T.

AU - Fischer, Thomas J.

AU - Floyd, Waldo E.

AU - Adams, Julie

AU - Sierra, Francisco Javier Aguilar

AU - Jason Palmer, M.

AU - Jacoby, Sidney

AU - Siff, Todd

AU - Swigart, Carrie

AU - DeSilva, Gregory

AU - Taras, John

AU - Wint, Jeffrey

AU - Calandruccio, Jim

AU - Shatford, Russell

AU - Hutchinson, Douglas T.

AU - Sasaki, Takashi

AU - Uhl, Richard

AU - Nolla, Jose

AU - Kakar, Sanjeev

AU - Bonatz, Ekkehard

AU - Papandrea, Rick

AU - Nancollas, Michael

AU - Ruggiero, Gustavo Mantovani

AU - Barth, Richard

AU - Bamberger, Brent

AU - McAuliffe, John

AU - Richard, Marc J.

AU - Baskies, Michael

AU - Mitchell, Scott

AU - Polatsch, Daniel

AU - Boretto, Jorge

AU - Lattanza, Lisa

AU - Rozental,

AU - Cassidy, Charles

AU - Kalainov, David M.

AU - Hofmeister, Eric

AU - Weiss, Lawrence

AU - Benson, Leon

AU - Baxamusa, Taizoon

AU - Hanel, Doug

AU - Suarez, Fabio

AU - Castillo, Alberto Pérez

AU - Miller, David R.

AU - Wilson, Chris

AU - Havenhill, Timothy G.

AU - Grafe, Michael W.

AU - Kaplan, Saul

AU - Spath, Catherine

AU - Walsh, Christopher J.

AU - Lee, Kendrick

AU - Howlett, John

AU - Potter, Loren

AU - McCulloch, Patrick T.

AU - Lumsden, Boyd

AU - Meyer, Nick

AU - Sutker, Ben

AU - Metzger, Charles

AU - Ortiz, Jose A.

AU - Helgemo, Steve

AU - Fanuele, Jason

AU - Pomerance, Jay

AU - Arnnold Batson, W.

AU - Hurwit, Shep

AU - Goslings, J. C.

AU - DeVine, John G.

AU - Edwards, Scott

AU - Hughes, Thomas

AU - Abdel-Ghany, Mahmoud I.

AU - Kleinlugtenbelt, I. J.V.

PY - 2014/7

Y1 - 2014/7

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84904129136&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84904129136&partnerID=8YFLogxK

U2 - 10.1007/s11999-014-3592-z

DO - 10.1007/s11999-014-3592-z

M3 - Article

C2 - 24711128

AN - SCOPUS:84904129136

SN - 0009-921X

VL - 472

SP - 2113

EP - 2119

JO - Clinical orthopaedics and related research

JF - Clinical orthopaedics and related research

IS - 7

ER -

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

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