TY - JOUR
T1 - Classification and Treatment of Pediatric Tibial Spine Fractures
T2 - Assessing Reliability among a Tibial Spine Research Interest Group
AU - Ellis, Henry B.
AU - Zynda, Aaron J.
AU - Cruz, Aristides I.
AU - Sachleben, Brant
AU - Sargent, Catherine
AU - Green, Daniel
AU - Schmale, Gregory
AU - Jagodzinski, Jason
AU - Rhodes, Jason
AU - Mistovich, Justin
AU - Fabricant, Peter D.
AU - Mckay, Scott
AU - Lee, Rushyuan J.
AU - Yen, Yi Meng
AU - Ganley, Theodore
N1 - Funding Information:
H.B.E. is a consultant for Smith-Nephew and receives educational sup-port from Arthrex. A.I.C. is a paid CME question writer for JBJS. D.G. receives royalties from Arthrex and Pega Medical. G.S. receives educational support from Arthrex. J.R. is a consultant for Ortho-paediatrics and received a research grant from Smith-Nephew for a different study. J.M. is a consultant for Orthopaediatrics and receives educational support from Depuy Synthes. R.J.L. receives educational support from Arthrex, Vericel, and Orthopaediatrics. Y-.M.Y. is a consultant for Smith-Nephew and receives hospitality payment from Kairos Surgical. T.G. receives educational support from Allosource, Arthrex, and Vericel. The remaining authors declare no conflicts of interest.
Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021/1
Y1 - 2021/1
N2 - Background: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.Methods: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.Results: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)].Conclusions: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 of Evidence:Level III - diagnostic reliability study of nonconsecutive patients.
AB - Background: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.Methods: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.Results: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)].Conclusions: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 of Evidence:Level III - diagnostic reliability study of nonconsecutive patients.
KW - Meyers and McKeever classification
KW - radiographic measurements
KW - reliability
KW - tibial spine avulsion
KW - tibial spine fracture
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U2 - 10.1097/BPO.0000000000001654
DO - 10.1097/BPO.0000000000001654
M3 - Article
C2 - 32991493
AN - SCOPUS:85095133261
SN - 0271-6798
VL - 41
SP - e20-e25
JO - Journal of Pediatric Orthopaedics
JF - Journal of Pediatric Orthopaedics
IS - 1
ER -