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 language | English (US) |
|---|---|
| Pages (from-to) | e337-e341 |
| Journal | Journal of Hand Surgery |
| Volume | 41 |
| Issue number | 10 |
| DOIs | |
| State | Published - Oct 1 2016 |
Keywords
- Interobserver study
- distal humerus fracture
- elbow trauma
ASJC Scopus subject areas
- Surgery
- Orthopedics and Sports Medicine
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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, C.; 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, P.; 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 journal › Article › peer-review
}
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, C.
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, P.
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.
N1 - Publisher Copyright: © 2016 American Society for Surgery of the Hand
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 - Interobserver study
KW - distal humerus fracture
KW - elbow trauma
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 - Journal of Hand Surgery
JF - Journal of Hand Surgery
SN - 0363-5023
IS - 10
ER -