Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX.
Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX.
J Hand Surg Am. 2022 Nov;47(11):1095-1100. doi: 10.1016/j.jhsa.2022.07.013. Epub 2022 Sep 6.
The 3-category rating of volar plate prominence in relation to the most volar edge of the distal radius (the watershed line) on lateral radiographs was reliable among a small group of surgeons and associated with the probability of flexor tendon irritation and potential rupture. Classifications are often less reliable when tested among a large group of practicing surgeons in different environments.
In this survey-based experiment, an international group of 115 fracture and upper extremity surgeons viewed 1 of 4 sets of 24 lateral radiographs (96 unique lateral radiographs) of patients with distal radius fractures who underwent volar plating in the practice of a single surgeon using 2 types of plates. Surgeons were asked to rate the following metrics: (1) the grade of plate prominence according to Soong, (2) whether the plate was more prominent than the watershed line, (3) whether the plate was separate from the bone distally, and (4) whether there is more than 5° of dorsal angulation of the distal radius articular surface.
The interobserver agreement of the classification was "fair" (κ = 0.32; 95% confidence interval [CI] = 0.27-0.36), and grading was more reliable among surgeons who do not supervise trainees. Volar prominence was less reliable (κ = 0.034; 95% CI = 0.013-0.055) than plate separation from bone (κ = 0.50; 95% CI = 0.42-0.59) and more than 5° of dorsal angulation (κ = 0.42; 95% CI = 0.35-0.48).
Among a large number of international practicing surgeons, the classification of volar plate prominence in 3 categories was fair.
The diagnosis of plate prominence might develop toward criteria with moderate reliability, such as separation of the plate from the bone and residual angulation of the distal radius.
在侧位 X 线片上，将舟状骨突出与桡骨远端最掌侧边缘（分水岭线）分为 3 个等级的方法在一小部分外科医生中是可靠的，并且与屈肌腱激惹和潜在断裂的可能性相关。当在不同环境中对大量实践外科医生进行测试时，分类通常不太可靠。
在这项基于调查的实验中，一个由 115 名骨折和上肢外科医生组成的国际小组，对一名外科医生手术治疗的 24 名患者中的 1 组（共 4 组）24 张侧位 X 线片（96 张侧位 X 线片）进行了评估。要求外科医生评估以下指标：（1）Soong 分级的钢板突出程度，（2）钢板是否比分水岭线更突出，（3）钢板是否与骨远端分离，以及（4）桡骨关节面是否有超过 5°的背侧成角。
分类的观察者间一致性为“中等”（κ=0.32；95%置信区间[CI]：0.27-0.36），并且在不监督受训者的外科医生中，分级更为可靠。掌侧突出比钢板与骨分离（κ=0.034；95%CI：0.013-0.055）和超过 5°的背侧成角（κ=0.42；95%CI：0.35-0.48）更不可靠。
在大量国际实践外科医生中，将掌侧钢板突出分为 3 类的分类方法是可靠的。
钢板突出的诊断可能朝着中度可靠的标准发展，例如钢板与骨分离和桡骨远端残留成角。
