Interpretation of Post-operative Distal Humerus Radiographs After Internal Fixation: Prediction of Later Loss of Fixation

Femke M A P Claessen, Nicky Stoop, David Ring, Job N. Doornberg, Thierry G. Guitton, Michel P J van den Bekerom, A. B. Spoor, A. Chauhan, A. L. Wahegaonkar, A. B. Shafritz, A. E. Garcia G, A. N. Miller, A. Barquet, A. Kristan, T. Apard, A. D. Armstrong, A. Berner, A. Jubel, B. E. Kreis, C. G. BabisB. Sutker, B. W. Sears, B. M. Nolan, B. D. Crist, B. J. Cross, B. P. Wills, C. J. Barreto, C. Ekholm, C. Swigart, C. D. Oliveira Miranda, C. Manke, C. Zalavras, C. A. Goldfarb, C. Cassidy, C. J. Walsh, C. M. Jones, C. Garnavos, C. Young, C. L. Moreno-Serrano, Craig Lomita, C. Klostermann, D. F. van Deurzen, D. A. Rikli, D. Polatsch, D. Beingessner, D. Drosdowech, D. Eygendaal, M. Patel, D. Brilej, E. T. Walbeehm, E. G. Ballas, E. F. Ibrahim, E. Melamed, E. Stojkovska Pemovska, E. Hofmeister, E. M. Hammerberg, F. T. Kaplan, F. Suarez, C. H. Fernandes, F. Lopez-Gonzalez, F. L. Walter, F. Frihagen, G. A. Kraan, G. Kontakis, G. S. Dyer, G. Kohut, G. Panagopoulos, G. R. Hernandez, G. Porcellini, G. J. Bayne, G. Merrell, G. DeSilva, G. J. Della Rocca, H. B. Bamberger, H. Broekhuyse, H. Durchholz, I. F. Kodde, I. McGraw, I. Harris, I. Pountos, J. M. Wiater, J. Choueka, J. E. Kazanjian, J. A. Gillespie, J. Biert, J. C. Fanuele, J. W. Johnson, J. A. Greenberg, J. Abrams, J. Hall, J. Fischer, J. H. Scheer, J. Itamura, J. T. Capo, J. Braman, J. Rubio, J. A. Ortiz, J. E. Filho, J. Nolla, J. Abboud, J. M. Conflitti, J. M. Abzug, J. M. Patiño, J. M. Rodríguez Roiz, J. Adams, J. Bishop, K. Kabir, K. Chivers, K. Prommersberger, K. Egol, K. M. Rumball, K. Dickson, K. Jeray, L. M. Poelhekke, L. A. Campinhos, L. Mica, L. C. Borris, L. E. Adolfsson, L. M. Schulte, L. Elmans, L. B. Lane, L. Paz, L. Taitsman, L. Guenter, L. S. Austin, M. Waseem, M. J. Palmer, M. I. Abdel-Ghany, M. J. Richard, M. Rizzo, M. Pirpiris, M. Di Micoli, M. Bonczar, M. I. Loebenberg, M. Richardson, M. Mormino, M. Menon, M. Soong, M. M. Wood, S. A. Meylaerts, M. Darowish, M. Nancollas, M. Prayson, M. W. Grafe, M. W. Kessler, M. D. Kaminaris, M. A. Pirela-Cruz, M. Mckee, M. Merchant, M. Tyllianakis, M. Shafi, A. J. Powell, N. L. Shortt, N. E. Felipe, N. Parnes, N. Bijlani, N. Elias, N. M. Akabudike, N. Rossiter, N. G. Lasanianos, N. K. Kanakaris, O. Brink, P. V. van Eerten, P. Paladini, P. A. Martineau, P. Appleton, Paul E. Levin, P. Althausen, P. J. Evans, P. Jebson, P. Krause, P. Schandelmaier, A. Peters, P. Dantuluri, P. Blazar, P. Andreas, P. Inna, M. Quell, R. M. Ramli, R. de Bedout, A. B. Ranade, S. Ashish, R. M. Smith, R. H. Babst, R. Omid, R. Buckley, R. Jenkinson, R. S. Gilbert, R. S. Page, R. Papandrea, R. D. Zura, R. L. Gray, R. Wagenmakers, R. Pesantez, R. van Riet, R. P. Calfee, S. H. van Helden, S. Bouaicha, S. Kakar, S. Kaplan, F. D. Scott, S. G. Kaar, S. Mitchell, S. Rowinski, S. Dodds, S. A. Kennedy, S. Beldner, T. Schepers, T. G. Guitton, T. Gosens, T. Baxamusa, C. Taleb, T. Tosounidis, T. Wyrick, T. Begue, T. DeCoster, T. Dienstknecht, T. F. Varecka, T. Mittlmeier, T. J. Fischer, T. Chesser, T. Omara, T. Bafus, T. Siff, T. Havlicek, V. J. Sabesan, V. S. Nikolaou, V. Philippe, V. Giordano, A. J. Vochteloo, W. A. Batson, W. C. Hammert, W. Satora, Y. Weil, D. Ruch, L. Marsh, M. Swiontkowski, S. Hurwit

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Purpose Stable fixation of distal humerus fracture fragments is necessary for adequate healing and maintenance of reduction. The purpose of this study was to measure the reliability and accuracy of interpretation of postoperative radiographs to predict which implants will loosen or break after operative treatment of bicolumnar distal humerus fractures. We also addressed agreement among surgeons regarding which fracture fixation will loosen or break and the influence of years in independent practice, location of practice, and so forth. Methods A total of 232 orthopedic residents and surgeons from around the world evaluated 24 anteroposterior and lateral radiographs of distal humerus fractures on a Web-based platform to predict which implants would loosen or break. Agreement among observers was measured using the multi-rater kappa measure. Results The sensitivity of prediction of failure of fixation of distal humerus fracture on radiographs was 63%, specificity was 53%, positive predictive value was 36%, the negative predictive value was 78%, and accuracy was 56%. There was fair interobserver agreement (κ = 0.27) regarding predictions of failure of fixation of distal humerus fracture on radiographs. Interobserver variability did not change when assessed for the various subgroups. Conclusions When experienced and skilled surgeons perform fixation of type C distal humerus fracture, the immediate postoperative radiograph is not predictive of fixation failure. Reoperation based on the probability of failure might not be advisable. Type of study/level of evidence Diagnostic III.

Original languageEnglish (US)
Pages (from-to)e337-e341
JournalJournal of Hand Surgery
Volume41
Issue number10
DOIs
StatePublished - Oct 1 2016

Fingerprint

Humerus
Fracture Fixation
Observer Variation
Reoperation
Maintenance

Keywords

  • distal humerus fracture
  • elbow trauma
  • Interobserver study

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Claessen, F. M. A. P., Stoop, N., Ring, D., Doornberg, J. N., Guitton, T. G., van den Bekerom, M. P. J., ... Hurwit, S. (2016). Interpretation of Post-operative Distal Humerus Radiographs After Internal Fixation: Prediction of Later Loss of Fixation. Journal of Hand Surgery, 41(10), e337-e341. https://doi.org/10.1016/j.jhsa.2016.07.094

Interpretation of Post-operative Distal Humerus Radiographs After Internal Fixation : Prediction of Later Loss of Fixation. / Claessen, Femke M A P; Stoop, Nicky; Ring, David; Doornberg, Job N.; Guitton, Thierry G.; van den Bekerom, Michel P J; Spoor, A. B.; Chauhan, A.; Wahegaonkar, A. L.; Shafritz, A. B.; Garcia G, A. E.; Miller, A. N.; Barquet, A.; Kristan, A.; Apard, T.; Armstrong, A. D.; Berner, A.; Jubel, A.; Kreis, B. E.; Babis, C. G.; Sutker, B.; Sears, B. W.; Nolan, B. M.; Crist, B. D.; Cross, B. J.; Wills, B. P.; Barreto, C. J.; Ekholm, C.; Swigart, C.; Oliveira Miranda, C. D.; Manke, C.; Zalavras, C.; Goldfarb, C. A.; Cassidy, C.; Walsh, C. J.; Jones, C. M.; Garnavos, C.; Young, C.; Moreno-Serrano, C. L.; Lomita, Craig; Klostermann, C.; van Deurzen, D. F.; Rikli, D. A.; Polatsch, D.; Beingessner, D.; Drosdowech, D.; Eygendaal, D.; Patel, M.; Brilej, D.; Walbeehm, E. T.; Ballas, E. G.; Ibrahim, E. F.; Melamed, E.; Stojkovska Pemovska, E.; Hofmeister, E.; Hammerberg, E. M.; Kaplan, F. T.; Suarez, F.; Fernandes, C. H.; Lopez-Gonzalez, F.; Walter, F. L.; Frihagen, F.; Kraan, G. A.; Kontakis, G.; Dyer, G. S.; Kohut, G.; Panagopoulos, G.; Hernandez, G. R.; Porcellini, G.; Bayne, G. J.; Merrell, G.; DeSilva, G.; Della Rocca, G. J.; Bamberger, H. B.; Broekhuyse, H.; Durchholz, H.; Kodde, I. F.; McGraw, I.; Harris, I.; Pountos, I.; Wiater, J. M.; Choueka, J.; Kazanjian, J. E.; Gillespie, J. A.; Biert, J.; Fanuele, J. C.; Johnson, J. W.; Greenberg, J. A.; Abrams, J.; Hall, J.; Fischer, J.; Scheer, J. H.; Itamura, J.; Capo, J. T.; Braman, J.; Rubio, J.; Ortiz, J. A.; Filho, J. E.; Nolla, J.; Abboud, J.; Conflitti, J. M.; Abzug, J. M.; Patiño, J. M.; Rodríguez Roiz, J. M.; Adams, J.; Bishop, J.; Kabir, K.; Chivers, K.; Prommersberger, K.; Egol, K.; Rumball, K. M.; Dickson, K.; Jeray, K.; Poelhekke, L. M.; Campinhos, L. A.; Mica, L.; Borris, L. C.; Adolfsson, L. E.; Schulte, L. M.; Elmans, L.; Lane, L. B.; Paz, L.; Taitsman, L.; Guenter, L.; Austin, L. S.; Waseem, M.; Palmer, M. J.; Abdel-Ghany, M. I.; Richard, M. J.; Rizzo, M.; Pirpiris, M.; Di Micoli, M.; Bonczar, M.; Loebenberg, M. I.; Richardson, M.; Mormino, M.; Menon, M.; Soong, M.; Wood, M. M.; Meylaerts, S. A.; Darowish, M.; Nancollas, M.; Prayson, M.; Grafe, M. W.; Kessler, M. W.; Kaminaris, M. D.; Pirela-Cruz, M. A.; Mckee, M.; Merchant, M.; Tyllianakis, M.; Shafi, M.; Powell, A. J.; Shortt, N. L.; Felipe, N. E.; Parnes, N.; Bijlani, N.; Elias, N.; Akabudike, N. M.; Rossiter, N.; Lasanianos, N. G.; Kanakaris, N. K.; Brink, O.; van Eerten, P. V.; Paladini, P.; Martineau, P. A.; Appleton, P.; Levin, Paul E.; Althausen, P.; Evans, P. J.; Jebson, P.; Krause, P.; Schandelmaier, P.; Peters, A.; Dantuluri, P.; Blazar, P.; Andreas, P.; Inna, P.; Quell, M.; Ramli, R. M.; de Bedout, R.; Ranade, A. B.; Ashish, S.; Smith, R. M.; Babst, R. H.; Omid, R.; Buckley, R.; Jenkinson, R.; Gilbert, R. S.; Page, R. S.; Papandrea, R.; Zura, R. D.; Gray, R. L.; Wagenmakers, R.; Pesantez, R.; van Riet, R.; Calfee, R. P.; van Helden, S. H.; Bouaicha, S.; Kakar, S.; Kaplan, S.; Scott, F. D.; Kaar, S. G.; Mitchell, S.; Rowinski, S.; Dodds, S.; Kennedy, S. A.; Beldner, S.; Schepers, T.; Guitton, T. G.; Gosens, T.; Baxamusa, T.; Taleb, C.; Tosounidis, T.; Wyrick, T.; Begue, T.; DeCoster, T.; Dienstknecht, T.; Varecka, T. F.; Mittlmeier, T.; Fischer, T. J.; Chesser, T.; Omara, T.; Bafus, T.; Siff, T.; Havlicek, T.; Sabesan, V. J.; Nikolaou, V. S.; Philippe, V.; Giordano, V.; Vochteloo, A. J.; Batson, W. A.; Hammert, W. C.; Satora, W.; Weil, Y.; Ruch, D.; Marsh, L.; Swiontkowski, M.; Hurwit, S.

In: Journal of Hand Surgery, Vol. 41, No. 10, 01.10.2016, p. e337-e341.

Research output: Contribution to journalArticle

Claessen, FMAP, Stoop, N, Ring, D, Doornberg, JN, Guitton, TG, van den Bekerom, MPJ, Spoor, AB, Chauhan, A, Wahegaonkar, AL, Shafritz, AB, Garcia G, AE, Miller, AN, Barquet, A, Kristan, A, Apard, T, Armstrong, AD, Berner, A, Jubel, A, Kreis, BE, Babis, CG, Sutker, B, Sears, BW, Nolan, BM, Crist, BD, Cross, BJ, Wills, BP, Barreto, CJ, Ekholm, C, Swigart, C, Oliveira Miranda, CD, Manke, C, Zalavras, C, Goldfarb, CA, Cassidy, C, Walsh, CJ, Jones, CM, Garnavos, C, Young, C, Moreno-Serrano, CL, Lomita, C, Klostermann, C, van Deurzen, DF, Rikli, DA, Polatsch, D, Beingessner, D, Drosdowech, D, Eygendaal, D, Patel, M, Brilej, D, Walbeehm, ET, Ballas, EG, Ibrahim, EF, Melamed, E, Stojkovska Pemovska, E, Hofmeister, E, Hammerberg, EM, Kaplan, FT, Suarez, F, Fernandes, CH, Lopez-Gonzalez, F, Walter, FL, Frihagen, F, Kraan, GA, Kontakis, G, Dyer, GS, Kohut, G, Panagopoulos, G, Hernandez, GR, Porcellini, G, Bayne, GJ, Merrell, G, DeSilva, G, Della Rocca, GJ, Bamberger, HB, Broekhuyse, H, Durchholz, H, Kodde, IF, McGraw, I, Harris, I, Pountos, I, Wiater, JM, Choueka, J, Kazanjian, JE, Gillespie, JA, Biert, J, Fanuele, JC, Johnson, JW, Greenberg, JA, Abrams, J, Hall, J, Fischer, J, Scheer, JH, Itamura, J, Capo, JT, Braman, J, Rubio, J, Ortiz, JA, Filho, JE, Nolla, J, Abboud, J, Conflitti, JM, Abzug, JM, Patiño, JM, Rodríguez Roiz, JM, Adams, J, Bishop, J, Kabir, K, Chivers, K, Prommersberger, K, Egol, K, Rumball, KM, Dickson, K, Jeray, K, Poelhekke, LM, Campinhos, LA, Mica, L, Borris, LC, Adolfsson, LE, Schulte, LM, Elmans, L, Lane, LB, Paz, L, Taitsman, L, Guenter, L, Austin, LS, Waseem, M, Palmer, MJ, Abdel-Ghany, MI, Richard, MJ, Rizzo, M, Pirpiris, M, Di Micoli, M, Bonczar, M, Loebenberg, MI, Richardson, M, Mormino, M, Menon, M, Soong, M, Wood, MM, Meylaerts, SA, Darowish, M, Nancollas, M, Prayson, M, Grafe, MW, Kessler, MW, Kaminaris, MD, Pirela-Cruz, MA, Mckee, M, Merchant, M, Tyllianakis, M, Shafi, M, Powell, AJ, Shortt, NL, Felipe, NE, Parnes, N, Bijlani, N, Elias, N, Akabudike, NM, Rossiter, N, Lasanianos, NG, Kanakaris, NK, Brink, O, van Eerten, PV, Paladini, P, Martineau, PA, Appleton, P, Levin, PE, Althausen, P, Evans, PJ, Jebson, P, Krause, P, Schandelmaier, P, Peters, A, Dantuluri, P, Blazar, P, Andreas, P, Inna, P, Quell, M, Ramli, RM, de Bedout, R, Ranade, AB, Ashish, S, Smith, RM, Babst, RH, Omid, R, Buckley, R, Jenkinson, R, Gilbert, RS, Page, RS, Papandrea, R, Zura, RD, Gray, RL, Wagenmakers, R, Pesantez, R, van Riet, R, Calfee, RP, van Helden, SH, Bouaicha, S, Kakar, S, Kaplan, S, Scott, FD, Kaar, SG, Mitchell, S, Rowinski, S, Dodds, S, Kennedy, SA, Beldner, S, Schepers, T, Guitton, TG, Gosens, T, Baxamusa, T, Taleb, C, Tosounidis, T, Wyrick, T, Begue, T, DeCoster, T, Dienstknecht, T, Varecka, TF, Mittlmeier, T, Fischer, TJ, Chesser, T, Omara, T, Bafus, T, Siff, T, Havlicek, T, Sabesan, VJ, Nikolaou, VS, Philippe, V, Giordano, V, Vochteloo, AJ, Batson, WA, Hammert, WC, Satora, W, Weil, Y, Ruch, D, Marsh, L, Swiontkowski, M & Hurwit, S 2016, 'Interpretation of Post-operative Distal Humerus Radiographs After Internal Fixation: Prediction of Later Loss of Fixation', Journal of Hand Surgery, vol. 41, no. 10, pp. e337-e341. https://doi.org/10.1016/j.jhsa.2016.07.094
Claessen, Femke M A P ; Stoop, Nicky ; Ring, David ; Doornberg, Job N. ; Guitton, Thierry G. ; van den Bekerom, Michel P J ; Spoor, A. B. ; Chauhan, A. ; Wahegaonkar, A. L. ; Shafritz, A. B. ; Garcia G, A. E. ; Miller, A. N. ; Barquet, A. ; Kristan, A. ; Apard, T. ; Armstrong, A. D. ; Berner, A. ; Jubel, A. ; Kreis, B. E. ; Babis, C. G. ; Sutker, B. ; Sears, B. W. ; Nolan, B. M. ; Crist, B. D. ; Cross, B. J. ; Wills, B. P. ; Barreto, C. J. ; Ekholm, C. ; Swigart, C. ; Oliveira Miranda, C. D. ; Manke, C. ; Zalavras, C. ; Goldfarb, C. A. ; Cassidy, C. ; Walsh, C. J. ; Jones, C. M. ; Garnavos, C. ; Young, C. ; Moreno-Serrano, C. L. ; Lomita, Craig ; Klostermann, C. ; van Deurzen, D. F. ; Rikli, D. A. ; Polatsch, D. ; Beingessner, D. ; Drosdowech, D. ; Eygendaal, D. ; Patel, M. ; Brilej, D. ; Walbeehm, E. T. ; Ballas, E. G. ; Ibrahim, E. F. ; Melamed, E. ; Stojkovska Pemovska, E. ; Hofmeister, E. ; Hammerberg, E. M. ; Kaplan, F. T. ; Suarez, F. ; Fernandes, C. H. ; Lopez-Gonzalez, F. ; Walter, F. L. ; Frihagen, F. ; Kraan, G. A. ; Kontakis, G. ; Dyer, G. S. ; Kohut, G. ; Panagopoulos, G. ; Hernandez, G. R. ; Porcellini, G. ; Bayne, G. J. ; Merrell, G. ; DeSilva, G. ; Della Rocca, G. J. ; Bamberger, H. B. ; Broekhuyse, H. ; Durchholz, H. ; Kodde, I. F. ; McGraw, I. ; Harris, I. ; Pountos, I. ; Wiater, J. M. ; Choueka, J. ; Kazanjian, J. E. ; Gillespie, J. A. ; Biert, J. ; Fanuele, J. C. ; Johnson, J. W. ; Greenberg, J. A. ; Abrams, J. ; Hall, J. ; Fischer, J. ; Scheer, J. H. ; Itamura, J. ; Capo, J. T. ; Braman, J. ; Rubio, J. ; Ortiz, J. A. ; Filho, J. E. ; Nolla, J. ; Abboud, J. ; Conflitti, J. M. ; Abzug, J. M. ; Patiño, J. M. ; Rodríguez Roiz, J. M. ; Adams, J. ; Bishop, J. ; Kabir, K. ; Chivers, K. ; Prommersberger, K. ; Egol, K. ; Rumball, K. M. ; Dickson, K. ; Jeray, K. ; Poelhekke, L. M. ; Campinhos, L. A. ; Mica, L. ; Borris, L. C. ; Adolfsson, L. E. ; Schulte, L. M. ; Elmans, L. ; Lane, L. B. ; Paz, L. ; Taitsman, L. ; Guenter, L. ; Austin, L. S. ; Waseem, M. ; Palmer, M. J. ; Abdel-Ghany, M. I. ; Richard, M. J. ; Rizzo, M. ; Pirpiris, M. ; Di Micoli, M. ; Bonczar, M. ; Loebenberg, M. I. ; Richardson, M. ; Mormino, M. ; Menon, M. ; Soong, M. ; Wood, M. M. ; Meylaerts, S. A. ; Darowish, M. ; Nancollas, M. ; Prayson, M. ; Grafe, M. W. ; Kessler, M. W. ; Kaminaris, M. D. ; Pirela-Cruz, M. A. ; Mckee, M. ; Merchant, M. ; Tyllianakis, M. ; Shafi, M. ; Powell, A. J. ; Shortt, N. L. ; Felipe, N. E. ; Parnes, N. ; Bijlani, N. ; Elias, N. ; Akabudike, N. M. ; Rossiter, N. ; Lasanianos, N. G. ; Kanakaris, N. K. ; Brink, O. ; van Eerten, P. V. ; Paladini, P. ; Martineau, P. A. ; Appleton, P. ; Levin, Paul E. ; Althausen, P. ; Evans, P. J. ; Jebson, P. ; Krause, P. ; Schandelmaier, P. ; Peters, A. ; Dantuluri, P. ; Blazar, P. ; Andreas, P. ; Inna, P. ; Quell, M. ; Ramli, R. M. ; de Bedout, R. ; Ranade, A. B. ; Ashish, S. ; Smith, R. M. ; Babst, R. H. ; Omid, R. ; Buckley, R. ; Jenkinson, R. ; Gilbert, R. S. ; Page, R. S. ; Papandrea, R. ; Zura, R. D. ; Gray, R. L. ; Wagenmakers, R. ; Pesantez, R. ; van Riet, R. ; Calfee, R. P. ; van Helden, S. H. ; Bouaicha, S. ; Kakar, S. ; Kaplan, S. ; Scott, F. D. ; Kaar, S. G. ; Mitchell, S. ; Rowinski, S. ; Dodds, S. ; Kennedy, S. A. ; Beldner, S. ; Schepers, T. ; Guitton, T. G. ; Gosens, T. ; Baxamusa, T. ; Taleb, C. ; Tosounidis, T. ; Wyrick, T. ; Begue, T. ; DeCoster, T. ; Dienstknecht, T. ; Varecka, T. F. ; Mittlmeier, T. ; Fischer, T. J. ; Chesser, T. ; Omara, T. ; Bafus, T. ; Siff, T. ; Havlicek, T. ; Sabesan, V. J. ; Nikolaou, V. S. ; Philippe, V. ; Giordano, V. ; Vochteloo, A. J. ; Batson, W. A. ; Hammert, W. C. ; Satora, W. ; Weil, Y. ; Ruch, D. ; Marsh, L. ; Swiontkowski, M. ; Hurwit, S. / Interpretation of Post-operative Distal Humerus Radiographs After Internal Fixation : Prediction of Later Loss of Fixation. In: Journal of Hand Surgery. 2016 ; Vol. 41, No. 10. pp. e337-e341.
@article{0995a1e542f74549b31efe82d53f2fdf,
title = "Interpretation of Post-operative Distal Humerus Radiographs After Internal Fixation: Prediction of Later Loss of Fixation",
abstract = "Purpose Stable fixation of distal humerus fracture fragments is necessary for adequate healing and maintenance of reduction. The purpose of this study was to measure the reliability and accuracy of interpretation of postoperative radiographs to predict which implants will loosen or break after operative treatment of bicolumnar distal humerus fractures. We also addressed agreement among surgeons regarding which fracture fixation will loosen or break and the influence of years in independent practice, location of practice, and so forth. Methods A total of 232 orthopedic residents and surgeons from around the world evaluated 24 anteroposterior and lateral radiographs of distal humerus fractures on a Web-based platform to predict which implants would loosen or break. Agreement among observers was measured using the multi-rater kappa measure. Results The sensitivity of prediction of failure of fixation of distal humerus fracture on radiographs was 63{\%}, specificity was 53{\%}, positive predictive value was 36{\%}, the negative predictive value was 78{\%}, and accuracy was 56{\%}. There was fair interobserver agreement (κ = 0.27) regarding predictions of failure of fixation of distal humerus fracture on radiographs. Interobserver variability did not change when assessed for the various subgroups. Conclusions When experienced and skilled surgeons perform fixation of type C distal humerus fracture, the immediate postoperative radiograph is not predictive of fixation failure. Reoperation based on the probability of failure might not be advisable. Type of study/level of evidence Diagnostic III.",
keywords = "distal humerus fracture, elbow trauma, Interobserver study",
author = "Claessen, {Femke M A P} and Nicky Stoop and David Ring and Doornberg, {Job N.} and Guitton, {Thierry G.} and {van den Bekerom}, {Michel P J} and Spoor, {A. B.} and A. Chauhan and Wahegaonkar, {A. L.} and Shafritz, {A. B.} and {Garcia G}, {A. E.} and Miller, {A. N.} and A. Barquet and A. Kristan and T. Apard and Armstrong, {A. D.} and A. Berner and A. Jubel and Kreis, {B. E.} and Babis, {C. G.} and B. Sutker and Sears, {B. W.} and Nolan, {B. M.} and Crist, {B. D.} and Cross, {B. J.} and Wills, {B. P.} and Barreto, {C. J.} and C. Ekholm and C. Swigart and {Oliveira Miranda}, {C. D.} and C. Manke and C. Zalavras and Goldfarb, {C. A.} and C. Cassidy and Walsh, {C. J.} and Jones, {C. M.} and C. Garnavos and C. Young and Moreno-Serrano, {C. L.} and Craig Lomita and C. Klostermann and {van Deurzen}, {D. F.} and Rikli, {D. A.} and D. Polatsch and D. Beingessner and D. Drosdowech and D. Eygendaal and M. Patel and D. Brilej and Walbeehm, {E. T.} and Ballas, {E. G.} and Ibrahim, {E. F.} and E. Melamed and {Stojkovska Pemovska}, E. and E. Hofmeister and Hammerberg, {E. M.} and Kaplan, {F. T.} and F. Suarez and Fernandes, {C. H.} and F. Lopez-Gonzalez and Walter, {F. L.} and F. Frihagen and Kraan, {G. A.} and G. Kontakis and Dyer, {G. S.} and G. Kohut and G. Panagopoulos and Hernandez, {G. R.} and G. Porcellini and Bayne, {G. J.} and G. Merrell and G. DeSilva and {Della Rocca}, {G. J.} and Bamberger, {H. B.} and H. Broekhuyse and H. Durchholz and Kodde, {I. F.} and I. McGraw and I. Harris and I. Pountos and Wiater, {J. M.} and J. Choueka and Kazanjian, {J. E.} and Gillespie, {J. A.} and J. Biert and Fanuele, {J. C.} and Johnson, {J. W.} and Greenberg, {J. A.} and J. Abrams and J. Hall and J. Fischer and Scheer, {J. H.} and J. Itamura and Capo, {J. T.} and J. Braman and J. Rubio and Ortiz, {J. A.} and Filho, {J. E.} and J. Nolla and J. Abboud and Conflitti, {J. M.} and Abzug, {J. M.} and Pati{\~n}o, {J. M.} and {Rodr{\'i}guez Roiz}, {J. M.} and J. Adams and J. Bishop and K. Kabir and K. Chivers and K. Prommersberger and K. Egol and Rumball, {K. M.} and K. Dickson and K. Jeray and Poelhekke, {L. M.} and Campinhos, {L. A.} and L. Mica and Borris, {L. C.} and Adolfsson, {L. E.} and Schulte, {L. M.} and L. Elmans and Lane, {L. B.} and L. Paz and L. Taitsman and L. Guenter and Austin, {L. S.} and M. Waseem and Palmer, {M. J.} and Abdel-Ghany, {M. I.} and Richard, {M. J.} and M. Rizzo and M. Pirpiris and {Di Micoli}, M. and M. Bonczar and Loebenberg, {M. I.} and M. Richardson and M. Mormino and M. Menon and M. Soong and Wood, {M. M.} and Meylaerts, {S. A.} and M. Darowish and M. Nancollas and M. Prayson and Grafe, {M. W.} and Kessler, {M. W.} and Kaminaris, {M. D.} and Pirela-Cruz, {M. A.} and M. Mckee and M. Merchant and M. Tyllianakis and M. Shafi and Powell, {A. J.} and Shortt, {N. L.} and Felipe, {N. E.} and N. Parnes and N. Bijlani and N. Elias and Akabudike, {N. M.} and N. Rossiter and Lasanianos, {N. G.} and Kanakaris, {N. K.} and O. Brink and {van Eerten}, {P. V.} and P. Paladini and Martineau, {P. A.} and P. Appleton and Levin, {Paul E.} and P. Althausen and Evans, {P. J.} and P. Jebson and P. Krause and P. Schandelmaier and A. Peters and P. Dantuluri and P. Blazar and P. Andreas and P. Inna and M. Quell and Ramli, {R. M.} and {de Bedout}, R. and Ranade, {A. B.} and S. Ashish and Smith, {R. M.} and Babst, {R. H.} and R. Omid and R. Buckley and R. Jenkinson and Gilbert, {R. S.} and Page, {R. S.} and R. Papandrea and Zura, {R. D.} and Gray, {R. L.} and R. Wagenmakers and R. Pesantez and {van Riet}, R. and Calfee, {R. P.} and {van Helden}, {S. H.} and S. Bouaicha and S. Kakar and S. Kaplan and Scott, {F. D.} and Kaar, {S. G.} and S. Mitchell and S. Rowinski and S. Dodds and Kennedy, {S. A.} and S. Beldner and T. Schepers and Guitton, {T. G.} and T. Gosens and T. Baxamusa and C. Taleb and T. Tosounidis and T. Wyrick and T. Begue and T. DeCoster and T. Dienstknecht and Varecka, {T. F.} and T. Mittlmeier and Fischer, {T. J.} and T. Chesser and T. Omara and T. Bafus and T. Siff and T. Havlicek and Sabesan, {V. J.} and Nikolaou, {V. S.} and V. Philippe and V. Giordano and Vochteloo, {A. J.} and Batson, {W. A.} and Hammert, {W. C.} and W. Satora and Y. Weil and D. Ruch and L. Marsh and M. Swiontkowski and S. Hurwit",
year = "2016",
month = "10",
day = "1",
doi = "10.1016/j.jhsa.2016.07.094",
language = "English (US)",
volume = "41",
pages = "e337--e341",
journal = "The Hand",
issn = "1753-1934",
publisher = "SAGE Publications Ltd",
number = "10",

}

TY - JOUR

T1 - Interpretation of Post-operative Distal Humerus Radiographs After Internal Fixation

T2 - Prediction of Later Loss of Fixation

AU - Claessen, Femke M A P

AU - Stoop, Nicky

AU - Ring, David

AU - Doornberg, Job N.

AU - Guitton, Thierry G.

AU - van den Bekerom, Michel P J

AU - Spoor, A. B.

AU - Chauhan, A.

AU - Wahegaonkar, A. L.

AU - Shafritz, A. B.

AU - Garcia G, A. E.

AU - Miller, A. N.

AU - Barquet, A.

AU - Kristan, A.

AU - Apard, T.

AU - Armstrong, A. D.

AU - Berner, A.

AU - Jubel, A.

AU - Kreis, B. E.

AU - Babis, C. G.

AU - Sutker, B.

AU - Sears, B. W.

AU - Nolan, B. M.

AU - Crist, B. D.

AU - Cross, B. J.

AU - Wills, B. P.

AU - Barreto, C. J.

AU - Ekholm, C.

AU - Swigart, C.

AU - Oliveira Miranda, C. D.

AU - Manke, C.

AU - Zalavras, C.

AU - Goldfarb, C. A.

AU - Cassidy, C.

AU - Walsh, C. J.

AU - Jones, C. M.

AU - Garnavos, C.

AU - Young, C.

AU - Moreno-Serrano, C. L.

AU - Lomita, Craig

AU - Klostermann, C.

AU - van Deurzen, D. F.

AU - Rikli, D. A.

AU - Polatsch, D.

AU - Beingessner, D.

AU - Drosdowech, D.

AU - Eygendaal, D.

AU - Patel, M.

AU - Brilej, D.

AU - Walbeehm, E. T.

AU - Ballas, E. G.

AU - Ibrahim, E. F.

AU - Melamed, E.

AU - Stojkovska Pemovska, E.

AU - Hofmeister, E.

AU - Hammerberg, E. M.

AU - Kaplan, F. T.

AU - Suarez, F.

AU - Fernandes, C. H.

AU - Lopez-Gonzalez, F.

AU - Walter, F. L.

AU - Frihagen, F.

AU - Kraan, G. A.

AU - Kontakis, G.

AU - Dyer, G. S.

AU - Kohut, G.

AU - Panagopoulos, G.

AU - Hernandez, G. R.

AU - Porcellini, G.

AU - Bayne, G. J.

AU - Merrell, G.

AU - DeSilva, G.

AU - Della Rocca, G. J.

AU - Bamberger, H. B.

AU - Broekhuyse, H.

AU - Durchholz, H.

AU - Kodde, I. F.

AU - McGraw, I.

AU - Harris, I.

AU - Pountos, I.

AU - Wiater, J. M.

AU - Choueka, J.

AU - Kazanjian, J. E.

AU - Gillespie, J. A.

AU - Biert, J.

AU - Fanuele, J. C.

AU - Johnson, J. W.

AU - Greenberg, J. A.

AU - Abrams, J.

AU - Hall, J.

AU - Fischer, J.

AU - Scheer, J. H.

AU - Itamura, J.

AU - Capo, J. T.

AU - Braman, J.

AU - Rubio, J.

AU - Ortiz, J. A.

AU - Filho, J. E.

AU - Nolla, J.

AU - Abboud, J.

AU - Conflitti, J. M.

AU - Abzug, J. M.

AU - Patiño, J. M.

AU - Rodríguez Roiz, J. M.

AU - Adams, J.

AU - Bishop, J.

AU - Kabir, K.

AU - Chivers, K.

AU - Prommersberger, K.

AU - Egol, K.

AU - Rumball, K. M.

AU - Dickson, K.

AU - Jeray, K.

AU - Poelhekke, L. M.

AU - Campinhos, L. A.

AU - Mica, L.

AU - Borris, L. C.

AU - Adolfsson, L. E.

AU - Schulte, L. M.

AU - Elmans, L.

AU - Lane, L. B.

AU - Paz, L.

AU - Taitsman, L.

AU - Guenter, L.

AU - Austin, L. S.

AU - Waseem, M.

AU - Palmer, M. J.

AU - Abdel-Ghany, M. I.

AU - Richard, M. J.

AU - Rizzo, M.

AU - Pirpiris, M.

AU - Di Micoli, M.

AU - Bonczar, M.

AU - Loebenberg, M. I.

AU - Richardson, M.

AU - Mormino, M.

AU - Menon, M.

AU - Soong, M.

AU - Wood, M. M.

AU - Meylaerts, S. A.

AU - Darowish, M.

AU - Nancollas, M.

AU - Prayson, M.

AU - Grafe, M. W.

AU - Kessler, M. W.

AU - Kaminaris, M. D.

AU - Pirela-Cruz, M. A.

AU - Mckee, M.

AU - Merchant, M.

AU - Tyllianakis, M.

AU - Shafi, M.

AU - Powell, A. J.

AU - Shortt, N. L.

AU - Felipe, N. E.

AU - Parnes, N.

AU - Bijlani, N.

AU - Elias, N.

AU - Akabudike, N. M.

AU - Rossiter, N.

AU - Lasanianos, N. G.

AU - Kanakaris, N. K.

AU - Brink, O.

AU - van Eerten, P. V.

AU - Paladini, P.

AU - Martineau, P. A.

AU - Appleton, P.

AU - Levin, Paul E.

AU - Althausen, P.

AU - Evans, P. J.

AU - Jebson, P.

AU - Krause, P.

AU - Schandelmaier, P.

AU - Peters, A.

AU - Dantuluri, P.

AU - Blazar, P.

AU - Andreas, P.

AU - Inna, P.

AU - Quell, M.

AU - Ramli, R. M.

AU - de Bedout, R.

AU - Ranade, A. B.

AU - Ashish, S.

AU - Smith, R. M.

AU - Babst, R. H.

AU - Omid, R.

AU - Buckley, R.

AU - Jenkinson, R.

AU - Gilbert, R. S.

AU - Page, R. S.

AU - Papandrea, R.

AU - Zura, R. D.

AU - Gray, R. L.

AU - Wagenmakers, R.

AU - Pesantez, R.

AU - van Riet, R.

AU - Calfee, R. P.

AU - van Helden, S. H.

AU - Bouaicha, S.

AU - Kakar, S.

AU - Kaplan, S.

AU - Scott, F. D.

AU - Kaar, S. G.

AU - Mitchell, S.

AU - Rowinski, S.

AU - Dodds, S.

AU - Kennedy, S. A.

AU - Beldner, S.

AU - Schepers, T.

AU - Guitton, T. G.

AU - Gosens, T.

AU - Baxamusa, T.

AU - Taleb, C.

AU - Tosounidis, T.

AU - Wyrick, T.

AU - Begue, T.

AU - DeCoster, T.

AU - Dienstknecht, T.

AU - Varecka, T. F.

AU - Mittlmeier, T.

AU - Fischer, T. J.

AU - Chesser, T.

AU - Omara, T.

AU - Bafus, T.

AU - Siff, T.

AU - Havlicek, T.

AU - Sabesan, V. J.

AU - Nikolaou, V. S.

AU - Philippe, V.

AU - Giordano, V.

AU - Vochteloo, A. J.

AU - Batson, W. A.

AU - Hammert, W. C.

AU - Satora, W.

AU - Weil, Y.

AU - Ruch, D.

AU - Marsh, L.

AU - Swiontkowski, M.

AU - Hurwit, S.

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Purpose Stable fixation of distal humerus fracture fragments is necessary for adequate healing and maintenance of reduction. The purpose of this study was to measure the reliability and accuracy of interpretation of postoperative radiographs to predict which implants will loosen or break after operative treatment of bicolumnar distal humerus fractures. We also addressed agreement among surgeons regarding which fracture fixation will loosen or break and the influence of years in independent practice, location of practice, and so forth. Methods A total of 232 orthopedic residents and surgeons from around the world evaluated 24 anteroposterior and lateral radiographs of distal humerus fractures on a Web-based platform to predict which implants would loosen or break. Agreement among observers was measured using the multi-rater kappa measure. Results The sensitivity of prediction of failure of fixation of distal humerus fracture on radiographs was 63%, specificity was 53%, positive predictive value was 36%, the negative predictive value was 78%, and accuracy was 56%. There was fair interobserver agreement (κ = 0.27) regarding predictions of failure of fixation of distal humerus fracture on radiographs. Interobserver variability did not change when assessed for the various subgroups. Conclusions When experienced and skilled surgeons perform fixation of type C distal humerus fracture, the immediate postoperative radiograph is not predictive of fixation failure. Reoperation based on the probability of failure might not be advisable. Type of study/level of evidence Diagnostic III.

AB - Purpose Stable fixation of distal humerus fracture fragments is necessary for adequate healing and maintenance of reduction. The purpose of this study was to measure the reliability and accuracy of interpretation of postoperative radiographs to predict which implants will loosen or break after operative treatment of bicolumnar distal humerus fractures. We also addressed agreement among surgeons regarding which fracture fixation will loosen or break and the influence of years in independent practice, location of practice, and so forth. Methods A total of 232 orthopedic residents and surgeons from around the world evaluated 24 anteroposterior and lateral radiographs of distal humerus fractures on a Web-based platform to predict which implants would loosen or break. Agreement among observers was measured using the multi-rater kappa measure. Results The sensitivity of prediction of failure of fixation of distal humerus fracture on radiographs was 63%, specificity was 53%, positive predictive value was 36%, the negative predictive value was 78%, and accuracy was 56%. There was fair interobserver agreement (κ = 0.27) regarding predictions of failure of fixation of distal humerus fracture on radiographs. Interobserver variability did not change when assessed for the various subgroups. Conclusions When experienced and skilled surgeons perform fixation of type C distal humerus fracture, the immediate postoperative radiograph is not predictive of fixation failure. Reoperation based on the probability of failure might not be advisable. Type of study/level of evidence Diagnostic III.

KW - distal humerus fracture

KW - elbow trauma

KW - Interobserver study

UR - http://www.scopus.com/inward/record.url?scp=84981747032&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84981747032&partnerID=8YFLogxK

U2 - 10.1016/j.jhsa.2016.07.094

DO - 10.1016/j.jhsa.2016.07.094

M3 - Article

C2 - 27522299

AN - SCOPUS:84981747032

VL - 41

SP - e337-e341

JO - The Hand

JF - The Hand

SN - 1753-1934

IS - 10

ER -