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Computed tomography of bicondylar tibial plateau fractures after distraction with a bridging external fixation

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Abstract

Background

The goal of this study was to compare the inter- and intra-observer reliabilities of computed tomography (CT) scans of bicondylar tibial plateau fractures (Bi-TPFs) with or without distraction with a bridging external fixation (EF) as interpreted by inexperienced surgeons.

Methods

Patients that underwent CT after distraction with a bridging EF were allocated to group 1 (n = 18), and patients that underwent CT before distraction with a bridging EF were allocated to group 2 (n = 18). Five observers were given plain radiographs and CT images to assess (survey 1) and this assessment was repeated six weeks later (survey 2). Agreements regarding fracture classification and pre-operative planning were evaluated using kappa coefficients. In addition, to evaluate fracture severity, we designed a severity score.

Results

Inter-observer reliabilities for fracture classification and pre-operative planning were higher in group 1 than in group 2. Surveys 1 and 2 revealed similar kappa coefficients in the two study groups. The mean absolute difference (MAD) in severity scores allocated at the two surveys was significantly different between the two groups (P = 0.045). Intra-observer reliabilities of fracture classification and pre-operative planning were also higher in group 1 than in group 2. In addition, level of training was found to have a significant impact on the MAD in severity scores (P = 0.007).

Conclusions

Inter- and intra-observer reliabilities for fracture classification and pre-operative planning were better for inexperienced surgeons when CT was performed after distraction with a bridging EF for Bi-TPFs. Thus, when staged treatment using EF is selected in Bi-TPF patients, the authors suggest that CT scans be performed after distraction with a bridging EF especially for inexperienced surgeons.

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Funding

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Yeungnam University Medical Center, 170 Hyeonchung-ro, Nam-gu, Daegu, 42415, South Korea

    Ryu Seung Min, Park Jae Woo, Moon Jeong Jae, Lim Seung Wan, Kwon Moon Soo & Shon Oog Jin

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  1. Ryu Seung Min
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  2. Park Jae Woo
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  3. Moon Jeong Jae
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  4. Lim Seung Wan
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  5. Kwon Moon Soo
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Correspondence to Shon Oog Jin.

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This study was approved by the institutional review board of our hospital.

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The authors declare that they have no conflict of interest.

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Ryu, S.M., Park, J.W., Moon, J.J. et al. Computed tomography of bicondylar tibial plateau fractures after distraction with a bridging external fixation. International Orthopaedics (SICOT) 42, 2451–2458 (2018). https://doi.org/10.1007/s00264-018-3853-7

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  • DOI: https://doi.org/10.1007/s00264-018-3853-7

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