TY - JOUR
T1 - Follow-up radiographs in isolated Greater Tuberosity fractures lead to a change in treatment recommendation; an online survey study
AU - van Wier, Marieke F.
AU - Amajjar, Ihsane
AU - Hagemeijer, Noortje C.
AU - Claessen, Femke M.A.P.
AU - van den Bekerom, Michel P.J.
AU - van Deurzen, Derek F.P.
PY - 2020/4
Y1 - 2020/4
N2 - Introduction: It is common practice to obtain follow-up radiographs of non-operatively treated isolated greater tuberosity (GT) fractures 1 to 2 weeks after trauma. However, the majority of non-operatively treated GT fractures remain stable and do not require reconsideration of the initial treatment decision. Radiological follow-up therefore might be unnecessary. Our primary objective was to study whether radiological folow-up changes the initial treatment recommendation, hypothesizing no change. Materials and methods: Radiographs of 25 patients diagnosed with an isolated GT fracture were selected from our hospital database and presented on a web-based platform. Sixty-eight trauma- and orthopedic surgeons evaluated these radiographs. First the radiographs directly post-trauma and then, in random order, the radiographs 5-14 days post-trauma alongside the first radiographs. Each observer evaluated each set of radiographs once. The observers answered which treatment they would recommend (non-operative/operative), and how certain they were about their advice (absolutely certain, certain, some doubt, very uncertain). Recommendation-consistency and inter-observer agreement are presented as percentages and intra class correlation coefficients (ICC). Results: Overall, 84% (95% CI 82.1–85.8) of treatment recommendations was unchanged after evaluation of the second radiograph. Agreement within each observer ranged from 60 to 98%. The mean proportion of patients about whom the observers were (absolutely) certain of their recommendation increased from 70% at the first evaluation to 83% at the second evaluation (12.8; 95% CI 9.8–15.9). Furthermore, the ICC between the surgeons improved from 0.37 (95% CI 0.26–0.54) for the first evaluation to 0.60 (95% CI 0.47–0.74) for the second. Conclusion: In 16% of the patients the treatment recommendation for an isolated GT fracture changed after the evaluation of radiographs 1 to 2 weeks post-trauma. In addition, surgeons were more certain about their recommendation and there was less inter-observer variation. Radiological follow-up of a non-operatively treated isolated GT fracture therefore seems justifiable. Level of evidence: III, diagnostic study.
AB - Introduction: It is common practice to obtain follow-up radiographs of non-operatively treated isolated greater tuberosity (GT) fractures 1 to 2 weeks after trauma. However, the majority of non-operatively treated GT fractures remain stable and do not require reconsideration of the initial treatment decision. Radiological follow-up therefore might be unnecessary. Our primary objective was to study whether radiological folow-up changes the initial treatment recommendation, hypothesizing no change. Materials and methods: Radiographs of 25 patients diagnosed with an isolated GT fracture were selected from our hospital database and presented on a web-based platform. Sixty-eight trauma- and orthopedic surgeons evaluated these radiographs. First the radiographs directly post-trauma and then, in random order, the radiographs 5-14 days post-trauma alongside the first radiographs. Each observer evaluated each set of radiographs once. The observers answered which treatment they would recommend (non-operative/operative), and how certain they were about their advice (absolutely certain, certain, some doubt, very uncertain). Recommendation-consistency and inter-observer agreement are presented as percentages and intra class correlation coefficients (ICC). Results: Overall, 84% (95% CI 82.1–85.8) of treatment recommendations was unchanged after evaluation of the second radiograph. Agreement within each observer ranged from 60 to 98%. The mean proportion of patients about whom the observers were (absolutely) certain of their recommendation increased from 70% at the first evaluation to 83% at the second evaluation (12.8; 95% CI 9.8–15.9). Furthermore, the ICC between the surgeons improved from 0.37 (95% CI 0.26–0.54) for the first evaluation to 0.60 (95% CI 0.47–0.74) for the second. Conclusion: In 16% of the patients the treatment recommendation for an isolated GT fracture changed after the evaluation of radiographs 1 to 2 weeks post-trauma. In addition, surgeons were more certain about their recommendation and there was less inter-observer variation. Radiological follow-up of a non-operatively treated isolated GT fracture therefore seems justifiable. Level of evidence: III, diagnostic study.
KW - Agreement on treatment
KW - Imaging
KW - Isolated greater tuberosity fracture
UR - http://www.scopus.com/inward/record.url?scp=85081578512&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85081578512&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.otsr.2019.12.005
DO - https://doi.org/10.1016/j.otsr.2019.12.005
M3 - Article
C2 - 32173302
SN - 1877-0568
VL - 106
SP - 255
EP - 259
JO - Orthopaedics and Traumatology: Surgery and Research
JF - Orthopaedics and Traumatology: Surgery and Research
IS - 2
ER -