To evaluate the interobserver variation for the AO/OTA fracture classification system: region forty-three-pilon fractures.
One senior attending, two fellows (one trauma, one foot and ankle), one ...junior orthopaedic resident, and one experienced research coordinator independently classified eighty-four sets of radiographs. The evaluator was blinded as to treatment and functional outcome. The radiographs initially used to manage the patients were evaluated; no special radiographs or standardized radiographic techniques were used. The kappa statistic, Williams index, and SAV statistic were calculated.
Using the SAV statistic to quantify rater agreement beyond that expected by chance alone, the average chance-adjusted agreement among the raters was 0.57 for fracture type, 0.43 for group, and 0.41 for subgroup. This is equivalent to moderate agreement (0.41 to 0.60). The kappa statistic was used to determine whether there was difficulty with any specific category of the AO type classification among raters for selecting fracture type (A, B, C). Kappa values were 0.49 for type A, 0.58 for type B, 0.57 for type C, all of which were considered adequate.
These data are similar to others reported for interobserver agreement with the AO/OTA fracture classification and other classification systems. The issue of individual judgement in taking a continuous variable (fracture pattern) and compartmentalizing it into a dichotomous variable (fracture classification system) is highlighted by these data. Determination of fracture types alone (type A, B, or C) would seem to be sufficient for clinical research where fracture severity should be reported as a variable.
The objective of this study is to determine the treatment result of severe fractures of the tibial pilon using a two-stage treatment plan with a singular implant type. The setting is a level 1 trauma ...centre, the design a consecutive series of patients with a retrospective data evaluation. Due to anatomical circumstances, soft-tissue treatment is extremely important for fractures of the tibial plafond. After promising results reported about a two-staged treatment plan with external fixation and secondary internal fixation, we incorporated this method in our treatment protocol. This consisted in a second stage of internal fixation with a specifically developed locked pilon plate with multi-directional applicable screws. Between March 2000 and February 2005, 42 patients with high-energy fractures of the tibial plafond were treated using a two-staged treatment plan: firstly the fracture was stabilized with an external fixator immobilizing the ankle joint. Secondly, after stabilization of the soft-tissue situation (mean 9.2 days) open reduction and internal fixation with a locked-screw plate was performed. Complications experienced included three cases of superficial wound necrosis, in two cases a deep vein thrombosis occurred. All fractures healed but two patients needed an early bone graft because of insufficient bony consolidation. At follow-up, six Patients had no deficit in the range of movement of the ankle compared with the unaffected side, 19 patients experienced a deficit of movement of less then one third compared to the opposite side. In 27 cases no or only mild posttraumatic arthritis of the ankle occurred. There was no secondary loss of reduction or need for arthrodesis. The mean AOFAS score was 73.4 (52–97). A two-stage treatment plan in fractures of the distal lower limb with external fixation followed by locked-plate osteosynthesis reduces local complications with a good functional result.
The purpose of this study was to prospectively evaluate the use of limited internal fixation and the application of a hybrid external fixator (tensioned wires distally and 5.0 mm half pins proximally ...attached to a semicircular frame without crossing the ankle joint) in the treatment of severe distal tibia fractures. This technique involves accurate reduction and fixation of the intraarticular component through an incision based over a fracture site followed by stabilization of the metaphysis with the hybrid external fixator. We studied 26 patients 15-55 years of age who were followed for 8-36 months. All fractures were within 5 cm of the joint. Seventeen fractures were intraarticular, nine extraarticular, and six open. Eleven patients required bone grafting. The average time to healing was 4.2 months. Using clinically based criteria, there were 81% good and excellent results overall, 70.5% for the 17 intraarticular fractures, and 69% for Ruedi type III fractures. Complications included one superficial and one deep infection, one 10 degrees varus malunion, and three pin tract infections. This method yielded results comparable with previous studies while reducing the amount of soft tissue dissection necessary for the placement of large plates. Soft tissue complications were infrequent and the goals of early motion and fracture stability were not sacrificed.
PDF
