Texas Scottish Rite Hospital for Children.
University of Texas Southwestern, Dallas.
J Pediatr Orthop. 2021 Jan;41(1):e20-e25. doi: 10.1097/BPO.0000000000001654.
Treatment decisions for patients with tibial spine fractures depend heavily on radiographic measurements. The purpose of this study was to determine whether existing classification systems and radiographic measurements are reliable among a multicenter tibial spine research interest group. A secondary purpose was to evaluate agreement in treatment of tibial spine fractures.
Using a deidentified radiographic imaging series and identical imaging software, we examined the interobserver and intraobserver reliability of the Meyers and McKeever classification, as well as a cohort of measurements of tibial spine fractures and treatment recommendations. Forty patients were included based on previous reliability studies. Interobserver and intraobserver data were analyzed using kappa and intraclass correlation coefficient reliability measures for categorical and continuous variables, respectively.
Good interobserver reliability was seen with superior displacement measurements of the anterior portion of the tibial spine fracture (0.73, 0.78) and excellent intraobserver reliability with an intraclass correlation coefficient of 0.81. Several measurements demonstrated moderate interobserver and intraobserver reliability including posterior-proximal displacement, and length and height of the tibial spine fracture. Moderate intraobserver reliability was seen with a majority of measurements and classification schemata (0.42 to 0.60) except for a poor agreement in posterior-sagittal displacement (0.27). Classifying tibial spine fractures according to the original Meyers and McKeever classification demonstrated fair agreement [κ=0.35, 0.33 (inter); 0.47 (intra)]. When combining Type III and IV, agreement increased for both reviews [κ=0.42, 0.44 (inter); 0.52 (intra)]. A total of 24 (60%) fractures were classified as 3 different types. There was fair agreement in both reviews regarding open reduction (either open or arthroscopic) versus closed reduction for initial treatment [κ=0.33, 0.38 (inter); 0.51 (intra)].
Measurement of superior displacement of the anterior portion of tibial spine fractures on the lateral images is the only radiographic assessment with good interobserver and intraobserver reliability. Reliability of radiographic measurements and a modified classification for tibial spine fractures remains fair, and perhaps unacceptable, even among a group of pediatric sports medicine specialty-trained surgeons.
Level III-diagnostic reliability study of nonconsecutive patients.
胫骨棘骨折的治疗决策在很大程度上取决于影像学测量。本研究旨在确定多中心胫骨棘研究兴趣小组中现有的分类系统和影像学测量是否可靠。次要目的是评估胫骨棘骨折治疗的一致性。
使用去识别放射影像学系列和相同的成像软件，我们检查了 Meyers 和 McKeever 分类的观察者间和观察者内可靠性，以及一系列胫骨棘骨折的测量和治疗建议。根据先前的可靠性研究，纳入了 40 名患者。使用kappa 和组内相关系数分别对分类变量和连续变量进行观察者间和观察者内数据的可靠性分析。
胫骨棘骨折前侧的上移测量具有良好的观察者间可靠性（0.73、0.78），观察者内可靠性极好，组内相关系数为 0.81。几个测量结果显示出中度的观察者间和观察者内可靠性，包括后近端位移以及胫骨棘的长度和高度。除了后矢状位位移的一致性较差（0.27）外，大多数测量结果和分类方案都显示出中度的观察者内可靠性（0.42 至 0.60）。根据原始 Meyers 和 McKeever 分类对胫骨棘骨折进行分类，显示出适度的一致性[κ=0.35、0.33（间）；0.47（内）]。当将 III 型和 IV 型合并时，两种检查的一致性均增加[κ=0.42、0.44（间）；0.52（内）]。总共 24 例（60%）骨折分为 3 种不同类型。两种检查在初始治疗中，对于切开复位（无论是切开还是关节镜下）与闭合复位，均显示出适度的一致性[κ=0.33、0.38（间）；0.51（内）]。
在侧位图像上测量胫骨棘前侧的上移是唯一具有良好观察者间和观察者内可靠性的放射学评估。即使在一群接受过小儿运动医学专业培训的外科医生中，胫骨棘骨折的放射学测量和改良分类的可靠性也只是适度的，可能是不可接受的。
非连续患者的 III 级诊断可靠性研究。
