Clinical Orthopaedics and Related Research®

, Volume 471, Issue 4, pp 1373–1378 | Cite as

Diagnosis of Elbow Fracture Patterns on Radiographs: Interobserver Reliability and Diagnostic Accuracy

  • Job N. Doornberg
  • Thierry G. Guitton
  • David RingEmail author
  • Science of Variation Group
Clinical Research



Studies of traumatic elbow instability suggest that recognition of a pattern in the combination and character of the fractures and joint displacements helps predict soft tissue injury and guide the treatment of traumatic elbow instability, but there is no evidence that patterns can be identified reliably.


We therefore determined (1) the interobserver reliability of identifying specific patterns of traumatic elbow instability on radiographs for subgroups of orthopaedic surgeons; and (2) the diagnostic accuracy of radiographic diagnosis.


Seventy-three orthopaedic surgeons evaluated 53 sets of radiographs and diagnosed one of five common patterns of traumatic elbow instability by using a web-based survey. The interobserver reliability was analyzed using Cohen’s multirater kappa. Intraoperative diagnosis was the reference for fracture pattern in calculations of the sensitivity, specificity, accuracy, and positive predictive and negative predictive values of radiographic diagnosis.


The overall interobserver reliability for patterns of traumatic elbow instability on radiographs was κ = 0.41. Treatment of greater than five such injuries a year was associated with greater interobserver agreement, but years in practice were not. Diagnostic accuracy ranged from 76% to 93% and was lowest for the terrible triad pattern of injury.


Specific patterns of traumatic elbow instability can be diagnosed with moderate interobserver reliability and reasonable accuracy on radiographs.

Level of Evidence

Level III, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.


Positive Predictive Value Negative Predictive Value Radial Head Soft Tissue Injury Interobserver Reliability 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  • Job N. Doornberg
    • 1
  • Thierry G. Guitton
    • 1
  • David Ring
    • 2
    Email author
  • Science of Variation Group
  1. 1.University of Amsterdam, Academic Medical CenterAmsterdamThe Netherlands
  2. 2.Harvard Medical SchoolOrthopaedic Hand and Upper Extremity Service, Massachusetts General HospitalBostonUSA

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