Department of Orthopedic Surgery, Joint Research, OLVG, Oosterpark 9, 1091 Amsterdam, The Netherlands.
Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, 1105, Amsterdam, The Netherlands.
Orthop Traumatol Surg Res. 2020 Apr;106(2):255-259. doi: 10.1016/j.otsr.2019.12.005. Epub 2020 Mar 12.
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.
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).
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.
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.
III, diagnostic study.
对非手术治疗的孤立性大结节（GT）骨折患者，在创伤后 1 至 2 周常规行随访 X 线检查。然而，大多数非手术治疗的 GT 骨折仍保持稳定，不需要重新考虑初始治疗决策。因此，放射学随访可能是不必要的。我们的主要目的是研究放射学随访是否会改变初始治疗建议，假设无变化。
从我院数据库中选择了 25 例诊断为孤立性 GT 骨折的患者的 X 线片，并在基于网络的平台上展示。68 名创伤和骨科医生评估了这些 X 线片。首先评估创伤后即刻的 X 线片，然后以随机顺序评估创伤后 5-14 天的 X 线片，以及最初的 X 线片。每位观察者仅评估一套 X 线片。每位观察者回答他们会推荐哪种治疗（非手术/手术），以及对他们的建议有多大把握（绝对确定、确定、有些怀疑、非常不确定）。治疗建议的一致性和观察者间的一致性用百分比和组内相关系数（ICC）表示。
总体而言，84%（95%CI 82.1-85.8）的治疗建议在评估第二次 X 线片后未发生变化。每位观察者的一致性范围为 60%至 98%。观察者对其推荐的绝对把握程度从第一次评估的 70%增加到第二次评估的 83%（12.8；95%CI 9.8-15.9）。此外，医生之间的 ICC 从第一次评估的 0.37（95%CI 0.26-0.54）提高到第二次评估的 0.60（95%CI 0.47-0.74）。
在 16%的患者中，在创伤后 1 至 2 周评估 X 线片后，孤立性 GT 骨折的治疗建议发生了改变。此外，医生对其建议更有把握，观察者间的差异也更小。因此，对非手术治疗的孤立性 GT 骨折进行放射学随访是合理的。
III 级，诊断研究。
