Traction radiographs versus CT in the evaluation of fracture morphology and consecutive treatment decisions in OTA/AO 43C3 fractures

Traction-Internal Rotation Radiograph Can Improve Agreement in AO/OTA Classification System for Intertrochanteric Fracture

Purpose

The objective of our study was to evaluate the inter- and intra-observer reliability of the standard anteroposterior of both hips, traction-internal rotation, and the combination of the two radiographs for intertrochanteric fracture.

Methods

In one hundred cases, three sets of radiographs of intertrochanteric fracture were prepared. Two senior and two junior orthopedic trauma surgeons were asked to classify the radiograph according to AO/OTA classification. The standard both hips radiograph, traction-internal rotation radiograph and combination of both techniques were evaluated. All radiographs were evaluated at two different points in time for all observers. The inter- and intra-observer reliability were analyzed with the Kappa agreement index.

Results

Inter-observer agreement for standard radiographs was "substantial" in one while "moderate" in five among observers. After adding the traction radiograph to the standard radiograph, the agreement was improved to "substantial" in 4 while the rest was "moderate."Intra-observer agreement for standard radiographs was "substantial" in two observers and "moderate" in two observers. Adding traction to standard radiographs resulted in "substantial" in three observers and "moderate" in one observer.Overall pattern stability was changed in 19% after adding the traction film. Thirty-four percent of the fracture which initially diagnosed as A2.1 was changed from stable to unstable fracture patterns after adding the traction film.

Conclusions

Adding traction-internal rotation radiograph to the standard radiograph is a useful method for improving agreement to classify intertrochanteric fracture regarding AO/OTA classification. This may be helpful in determining fracture classification.

Comparison of Computed Tomography, Traction, and Inverted Grayscale Radiographs for Understanding Pilon Fracture Morphology

BACKGROUND

There have been no studies evaluating the usefulness of grayscale radiographs in extremity fractures. We aimed to compare the ability and reliability of traction radiographs vs traction grayscale inversion radiographs to detect fracture fragment and comminution zones in comminuted tibia pilon fractures.

METHODS

Plain radiographs and grayscale inversion images of 60 patients with Orthopaedic Trauma Association/AO Foundation type C3 fracture were evaluated by 20 observers (15 orthopaedic surgeons and 5 radiologists) after traction had been applied. The anterolateral, posterolateral, and medial malleolar fragments, as well as the lateral, central, and medial column comminution zones, were identified by all physicians. Computed tomography scan images were used as the "gold standard" against which plain radiographs and grayscale inversion image interpretation were measured. Intra- and interobserver reliability and correct identification of fracture fragments and comminution zones were evaluated.

RESULTS

The interobserver reliability for 3 of the fracture fragments and comminution zones on the traction plain radiographs was moderate, whereas it was substantial on traction grayscale inversion radiographs. The lateral comminution zones (P = .001) and presence or absence of posterolateral fragments (P < .001) were significantly better identified in grayscale inversion radiographs compared to standard radiographs.

CONCLUSION

After traction was applied, we found grayscale inversion radiographs are superior to plain radiographs in the identification of posterolateral fragment and lateral zone of comminution in comminuted intraarticular pilon fractures.

LEVEL OF EVIDENCE

Level III, retrospective case series.