Two-dimensional (2-D) and three-dimensional (3-D) computed tomography (CT) have been increasingly used in various intra-articular fractures including pilon fracture. However, no study has investigated intraobserver and interobserver reliabilities of pilon fracture classification using 3-D CT images.
(1) Intraobserver and interobserver agreements of fracture classifications and treatment recommendations will improve by using 2-D CT images compared to using plain radiographs only; (2) agreements will improve by adding 3-D CT images compared to adding 2-D CT images; and (3) agreements of orthopedic residents rather than specialists will be influenced more by imaging modality.
Materials and methods
Ten orthopedic specialists and 10 residents completed a survey to classify the fractures according to the Rüedi-Allgöwer and AO/OTA classifications and to select treatment options using 25 pilon fracture images. The survey was conducted using plain radiographs, with 2-D and 3-D CT images introduced 3 and 6 weeks later, respectively. Kappa coefficients were calculated to determine reliabilities.
Intraobserver reliabilities for fracture classifications in specialists significantly improved by using 2-D images compared to using plain radiographs only. Addition of 3D-CT did not significantly improve intraobserver reliabilities compared to those with 2-D CT. Use of 2-D CT images significantly improved overall interobserver agreement of both classifications, with the improvement being greater for residents. Use of 3-D CT images did not improve the interobserver reliability of both classifications. Overall interobserver reliabilities for treatment recommendations did not significantly differ according to the imaging modality. However, interobserver agreement among residents significantly improved from slight agreement using radiographs only to fair agreement using 2-D CT images.
Intraobserver and interobserver reliabilities of pilon fracture classification and treatment recommendations did not improve between using 3-D and 2-D CT. Using 2-D CT images improved the intraobserver and interobserver reliabilities of the fracture classifications in specialists and the interobserver reliabilities of the fracture classifications and the treatment recommendations in residents.
Level of evidence
IV, case control study.Le texte complet de cet article est disponible en PDF.
Keywords : Pilon fracture, Intraobserver reliability, Interobserver reliability, AO classification, Rüedi-Allgöwer classification, 3D CT
Abbreviations : 2-D, 3-D, CT
|☆|| Cet article peut être consulté in extenso dans la version anglaise de la revue Orthopaedics & Traumatology: Surgery & Research sur Science Direct (sciencedirect.com) en utilisant le DOI ci-dessus.
Vol 105 - N° 7P. 900-901 - novembre 2019 Retour au numéro
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement ou un achat à l’unité.
L'accès au texte intégral de cet article nécessite un abonnement ou un achat à l'unité.