Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO.
J Orthop Trauma. 2021 Dec 1;35(12):650-653. doi: 10.1097/BOT.0000000000002125.
To determine the agreement between fellowship-trained orthopaedic trauma surgeons in evaluating sacral fracture completeness in the setting of minimally displaced lateral compression type 1 pelvic ring injuries.
Survey study.
Urban Level 1 trauma center.
PATIENTS/PARTICIPANTS: This study included 10 fellowship-trained orthopaedic trauma surgeons reviewing 10 cases of minimally displaced lateral compression type 1 injuries with proven occult instability (≥10 mm of fracture displacement on lateral stress radiographs). Sacral fractures were considered complete (n = 5; fracture line exiting posterior cortex of sacrum) or incomplete (n = 5).
Participants reviewed videos of all axial computed tomography images of the sacrum and were asked if the sacral fracture was complete or incomplete.
Interobserver reliability of completeness of sacral fracture.
Interobserver reliability among surgeons for completeness of sacral fractures was considered to be weak (k = 0.46) with a 95% confidence interval that ranged from minimal (k = 0.37) to weak (k = 0.55). None of the 5 unstable sacral fractures that were considered to be complete garnered 100% agreement among surgeons. Agreement for each of these cases ranged from 40% to 90%. In contrast, 4 of the 5 unstable sacral fractures considered to be incomplete had 100% agreement.
Completeness of sacral fractures had weak interobserver reliability among fellowship-trained orthopaedic trauma surgeons. Sacral fractures that were considered incomplete by all surgeons did have occult instability. These results highlight the large potential for error created by using sacral fracture completeness as a criterion to rule out occult instability.
Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
确定在最小移位外侧压缩 1 型骨盆环损伤的情况下，接受过 fellowship 培训的骨科创伤外科医生在评估骶骨骨折完整性方面的一致性。
调查研究。
城市 1 级创伤中心。
患者/参与者：本研究纳入了 10 名接受过 fellowship 培训的骨科创伤外科医生，他们对 10 例最小移位外侧压缩 1 型损伤患者进行了评估，这些患者有明确的隐匿性不稳定（侧位应力射线照相上的骨折移位≥10mm）。骶骨骨折被认为是完整的（n=5；骨折线从骶骨后皮质穿出）或不完整的（n=5）。
参与者查看了所有骶骨轴向 CT 图像的视频，并被问及骶骨骨折是否完整或不完整。
骶骨骨折完整性的观察者间可靠性。
外科医生对骶骨骨折完整性的判断存在较弱的观察者间一致性（k=0.46），95%置信区间为最小（k=0.37）至弱（k=0.55）。在被认为是完整的 5 例不稳定骶骨骨折中，没有一例得到了所有外科医生的 100%一致意见。这些病例的每例的一致性范围为 40%至 90%。相比之下，被认为不完整的 5 例不稳定骶骨骨折中有 4 例得到了 100%的一致意见。
在接受过 fellowship 培训的骨科创伤外科医生中，骶骨骨折的完整性判断存在较弱的观察者间可靠性。所有外科医生都认为不完整的骶骨骨折确实存在隐匿性不稳定。这些结果突出了将骶骨骨折完整性作为排除隐匿性不稳定的标准所带来的巨大误差风险。
诊断 III 级。有关证据水平的完整描述，请参见作者说明。
