Skip to main content
SpringerLink
Log in

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

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

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.

Questions/Purposes

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.

Methods

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.

Results

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.

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20:37–46.

    Article  Google Scholar 

  2. Doornberg J, Ring D, Jupiter JB. Effective treatment of fracture-dislocations of the olecranon requires a stable trochlear notch. Clin Orthop Relat Res. 2004;429:292–300.

    Article  PubMed  Google Scholar 

  3. Doornberg JN, Ring D. Coronoid fracture patterns. J Hand Surg Am. 2006;31:45–52.

    Article  PubMed  Google Scholar 

  4. Doornberg JN, Ring DC. Fracture of the anteromedial facet of the coronoid process. J Bone Joint Surg Am. 2006;88:2216–2224.

    Article  PubMed  Google Scholar 

  5. Giannicola G, Sacchetti FM, Greco A, Cinotti G, Postacchini F. Management of complex elbow instability. Musculoskelet Surg. 2010;94(suppl 1):S25–36.

    Article  PubMed  Google Scholar 

  6. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–174.

    Article  PubMed  CAS  Google Scholar 

  7. McKee MD, Pugh DM, Wild LM, Schemitsch EH, King GJ. Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures: surgical technique. J Bone Joint Surg Am. 2005;87(suppl 1):22–32.

    PubMed  Google Scholar 

  8. McKee MD, Schemitsch EH, Sala MJ, O’driscoll SW. The pathoanatomy of lateral ligamentous disruption in complex elbow instability. J Shoulder Elbow Surg. 2003;12:391–396.

    Article  PubMed  Google Scholar 

  9. O’Driscoll SW, Jupiter JB, Cohen MS, Ring D, McKee MD. Difficult elbow fractures: pearls and pitfalls. Instr Course Lect. 2003;52:113–134.

    PubMed  Google Scholar 

  10. Pollock JW, Brownhill J, Ferreira L, McDonald CP, Johnson J, King G. The effect of anteromedial facet fractures of the coronoid and lateral collateral ligament injury on elbow stability and kinematics. J Bone Joint Surg Am. 2009;91:1448–1458.

    Article  PubMed  Google Scholar 

  11. Posner KL, Sampson PD, Caplan RA, Ward RJ, Cheney FW. Measuring interrater reliability among multiple raters: an example of methods for nominal data. Stat Med. 1990;9:1103–1115.

    Article  PubMed  CAS  Google Scholar 

  12. Ring D, Jupiter JB. Fracture dislocation of the elbow. J Bone Joint Surg Am. 1998;80:566–580.

    Article  PubMed  CAS  Google Scholar 

  13. Ring D, Jupiter JB. Reconstruction of posttraumatic elbow instability. Clin Orthop Relat Res. 2000;370:44–56.

    Article  PubMed  Google Scholar 

  14. Ring D, Jupiter JB, Sanders RW, Mast J, Simpson NS. Transolecranon fracture-dislocation of the elbow. J Orthop Trauma. 1997;11:545–550.

    Article  PubMed  CAS  Google Scholar 

  15. Ring D, Jupiter JB, Zilberfarb J. Posterior dislocation of the elbow with fractures of the radial head and coronoid. J Bone Joint Surg Am. 2002;84:547–551.

    PubMed  Google Scholar 

  16. Siegel S, Castellan NJ. Nonparametric Statistics for the Behavioral Sciences. New York, NY: McGraw-Hill; 1988.

    Google Scholar 

  17. Sotereanos DG, Darlis NA, Wright TW, Goitz RJ, King GJ. Unstable fracture dislocations of the elbow. Instr Course Lect. 2007;56:369–376.

    PubMed  Google Scholar 

  18. Tashjian RZ, Katarincic JA. Complex elbow instability. J Am Acad Orthop Surg. 2006;14:278–286.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands

    Job N. Doornberg MD, PhD & Thierry G. Guitton PhD

  2. Harvard Medical School, Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA, USA

    David Ring MD, PhD

Authors
  1. Job N. Doornberg MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thierry G. Guitton PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David Ring MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

Science of Variation Group

Corresponding author

Correspondence to David Ring MD, PhD.

Additional information

Science of Variation Group: Andrew Schmidt, Antonio Barquet, Ashok K. Shyam, Brett D. Crist, Carrie Swigart, Chad Coles, Charalampos Zalavras, Charles A. Goldfarb, Charles Cassidy, Daphne Beingessner, David M. Kalainov, David Ruchelsman, Denise Eygendaal, Elena Grosso, Eric Mark Hammerberg, Frede Frihagen, George Dyer, George S. Athwal, George Thomas, Gregory J. Della Rocca, Ian Harris, J.C. Goslings, Jan Biert, Jason Fanuele, Jeff Lawton, Jeffrey A. Greenberg, John Jiuliano, John McAuliffe, John T. Capo, John Taras, Jorge Orbay, Joseph M. Conflitti, Keith Segalman, Kenneth Egol, Kyle Jeray, Lee Osterman, Leon Elmans, Lisa Lattanza, Lisa Taitsman, Louis Catalano III, M Baumgaertner, Marc Swiontkowski, Martin Boyer, Martin Richardson, Matthew Camuso, Michael Baskies, Michael Prayson, Neal Chen, P.V. van Eerten, Parag Sancheti, Paul Levin, Paul Tornetta, Peter Brink, Peter J. Evans, Peter Jebson, Peter Kloen, Phani Dantuluri, Philip Blazar, Richard S. Page, Rick Papandrea, Rob Nelissen, Robert D. Zura, Robert J. Feibel MD, Robert Probe, Rodrigo Pesantez, S. Rhemrev, Samir Sodha, Scott Duncan, Scott Wolfe, Taco Gosens, Thomas Higgins, Thomas Hughes, Thomas Wright.

One of the authors certifies that he (DR) has or may receive payments or benefits, during the study period, an amount of less than $10,000 from Wright Medical (DR) (Arlington, TN, USA) and Biomet (DR) (Warsaw, IN, USA). The institution of one or more of the authors (DR) has received funding from Skeletal Dynamics (DR)(Miami, FL, USA) and Biomet (DR)(Warsaw, IN, USA).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

This work was performed at University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands and Harvard Medical School, Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA, USA.

Appendices

Appendices

Appendix 1 Agreement per case
Full size table
Appendix 2 Diagnostic accuracy of using plain radiographs to identify elbow fracture patterns - Statistical Analysis
Full size table

About this article

Cite this article

Doornberg, J.N., Guitton, T.G., Ring, D. et al. Diagnosis of Elbow Fracture Patterns on Radiographs: Interobserver Reliability and Diagnostic Accuracy. Clin Orthop Relat Res 471, 1373–1378 (2013). https://doi.org/10.1007/s11999-012-2742-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-012-2742-4

Keywords

Search

Navigation