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Objectives: To evaluate the interobserver reliability of measured displacement and occult instability of minimally displaced lateral compression type 1 (LC1) fractures on lateral stress radiographs (LSRs) and to compare differences in displacement between LSR with the injured side down (ID) and up (IU).

Design: Retrospective review.

Setting: Urban Level 1 trauma center.

Patients/participants: Twenty-three adult patients with minimally displaced (<1 cm) LC1 injuries.

Intervention: None.

Main Outcome Measurements: Three orthopaedic surgeons measured the distance between the radiographic teardrops on LSR and supine anteroposterior pelvic radiographs to calculate dynamic fracture displacement. The interobserver reliability of the measured displacement, a continuous variable, was assessed by calculating the intraclass correlation coefficient. The interobserver reliability of occult instability (≥10 mm of displacement on LSR), a categorical variable, was assessed by calculating the kappa value. Matched-pairs analysis was performed to calculate the mean difference of measurements between observers and between ID and IU LSR.

Results: The interobserver reliability of the measured displacement was excellent (intraclass correlation coefficient 0.93). The mean difference in measurements between observers ranged from -1.8 to 0.96 mm. The mean difference in the measured displacement between ID and IU LSRs for each observer ranged from -0.6 to 0.3 mm. There was 83% (19/23 cases) agreement on the presence of occult instability (≥10 mm of displacement on LSR) on both ID and IU LSRs. The interobserver reliability of occult instability was moderate (kappa 0.76).

Conclusions: Measured fracture displacement and occult instability of minimally displaced LC1 injuries were reliably measured and identified on LSR, regardless of the laterality.

Competing Interests: The authors report no conflict of interest.

Titel:	Lateral Stress Radiographs of Lateral Compression Type 1 Pelvic Injuries, With the Injured Side Down or Up, Reliably Measure Occult Instability.
Autor/in / Beteiligte Person:	Parry, JA ; Hadeed, MM ; Strage, KE ; Heare, A ; Stacey, SC ; Mauffrey, C
Zeitschrift:	Journal of orthopaedic trauma, Jg. 36 (2022-10-01), Heft 10, S. 494-497
Veröffentlichung:	Hagerstown, MD : Lippincott Williams & Wilkins ; <i>Original Publication</i>: [New York, N.Y.] : Raven Press, [c1987-, 2022
Medientyp:	academicJournal
ISSN:	1531-2291 (electronic)
DOI:	10.1097/BOT.0000000000002374
Schlagwort:	Adult Humans Observer Variation Radiography Reproducibility of Results Retrospective Studies Trauma Centers Fractures, Compression diagnostic imaging
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Journal Article Language: English [J Orthop Trauma] 2022 Oct 01; Vol. 36 (10), pp. 494-497. MeSH Terms: Fractures, Compression* / diagnostic imaging ; Adult ; Humans ; Observer Variation ; Radiography ; Reproducibility of Results ; Retrospective Studies ; Trauma Centers References: Parry JA, Funk A, Heare A, et al. An international survey of pelvic trauma surgeons on the management of pelvic ring injuries. Injury. 2021;52:2685–2692. ; Kuršumović K, Hadeed M, Bassett J, et al. Lateral compression type 1 (LC1) pelvic ring injuries: a spectrum of fracture types and treatment algorithms. Eur J Orthop Surg Traumatol. 2021;31:841–854. ; Bruce B, Reilly M, Sims S. OTA highlight paper predicting future displacement of nonoperatively managed lateral compression sacral fractures: can it Be done? J Orthop Trauma. 2011;25:523–527. ; Hagen J, Castillo R, Dubina A, et al. Does surgical stabilization of lateral compression-type pelvic ring fractures decrease patients' pain, reduce narcotic use, and improve mobilization? Clin Orthop Relat Res. 2016;474:1422–1429. ; Sembler Soles GL, Lien J, Tornetta P. Nonoperative immediate weightbearing of minimally displaced lateral compression sacral fractures does not result in displacement. J Orthop Trauma. 2012;26:563–567. ; Sagi HC, Coniglione FM, Stanford JH. Examination under anesthetic for occult pelvic ring instability. J Orthop Trauma. 2011;25:529–536. ; Parry JA, Salameh M, Maher MH, et al. The lateral stress radiograph identifies occult instability of lateral compression pelvic ring injuries without sedation. J Orthop Trauma. 2020;34:567–571. ; Whiting PS, Auston D, Avilucea FR, et al. Negative stress examination under anesthesia reliably predicts pelvic ring union without displacement. J Orthop Trauma. 2017;31:189–193. ; Denis F, Davis S, Comfort T. Sacral fractures: an important problem. Retrospective analysis of 236 cases. Clin Orthop Relat Res. 1988;227:67–81. ; Bujang M, Baharum N. Sample size guideline for correlation analysis. World J Soc Sci Res. 2016;3:37. ; McHugh ML. Interrater reliability: the Kappa statistic. Biochem Med (Zagreb). 2012;22:276–282. ; Tucker D, Carney J, Nguyen A, et al. Examination under anesthesia improves agreement on mechanical stability: a survey of experienced pelvic surgeons. J Orthop Trauma. 2021;35:e241–e246. ; Jacobs R, Kleweno C, Wallace S, et al. Validation of relative motion measurement method of lateral compression pelvic fractures during examination under anesthesia. J Orthop Trauma. 2021;35:e289–e292. ; Hadeed M, Strage K, Heare A, et al. Sacral fracture completeness in lateral compression type 1 pelvic ring injuries has weak interobserver reliability. J Orthop Trauma. 2021;35:650–653. ; Parry JA, Salameh M, Funk A, et al. Mobilization versus displacement on lateral stress radiographs for determining operative fixation of minimally displaced lateral compression type I (LC1) pelvic ring injuries. Int Orthop. 2021;45:1625–1631. ; Gaski GE, Manson TT, Castillo RC, et al. Nonoperative treatment of intermediate severity lateral compression type 1 pelvic ring injuries with minimally displaced complete sacral fracture. J Orthop Trauma. 2014;28:674–680. Entry Date(s): Date Created: 20220412 Date Completed: 20220920 Latest Revision: 20221110 Update Code: 20231215

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Lateral Stress Radiographs of Lateral Compression Type 1 Pelvic Injuries, With the Injured Side Down or Up, Reliably Measure Occult Instability.