Le suivi radiographique des fractures isolées du tubercule majeur huméral conduit-il à un changement des recommandations thérapeutiques ? Résultats d'une enquête en ligne
| Autor: | Noortje C. Hagemeijer, Marieke F. van Wier, Derek F.P. van Deurzen, Ihsane Amajjar, Michel P.J. van den Bekerom, Femke M.A.P. Claessen |
|---|---|
| Přispěvatelé: | Graduate School, AMS - Sports & Work, Amsterdam Movement Sciences, AMS - Ageing & Morbidty, APH - Personalized Medicine, APH - Quality of Care, Orthopedic Surgery and Sports Medicine |
| Jazyk: | francouzština |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Intraclass correlation business.industry Radiography Absolutely Certain Isolated greater tuberosity fracture Imaging Random order Radiological weapon Orthopedic surgery medicine Initial treatment Orthopedics and Sports Medicine Surgery business Nuclear medicine Agreement on treatment |
| Zdroj: | Revue de Chirurgie Orthopedique et Traumatologique, 106(2). Elsevier Masson |
| ISSN: | 1877-0517 |
| Popis: | 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 follow-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. |
| Databáze: | OpenAIRE |
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