Guesstimation of posterior malleolar fractures on lateral plain radiographs

D.T. Meijer; J.N. Doornberg; I.N. Sierevelt; W.H. Mallee; C.N. Van Dijk; G.M. Kerkhoffs; S.A. Stufkens; E. Palmanovich; M. Van Sterkenburg; A. Engvall; E. Arroyo; M. Golovakha; E. Pereira; E.T. Josep Torrent; D. Haverkamp; I. Bojanic; M. Sousa; O.C. Aragon; A. Russo; C. Cortes; G. Pánics; J. Vide; L. Spanos; M.S. Carvalho; P. Maggi; Z. Thomas; H. Tanaka; M. Dinato; J. Fay; V. Kimtys; A.J. Correia Moreira; D. Hatziemmanuil; T.-C. Low; L.W. Van Der Plaat; A.D. Mora; I. Van Rensen; J. Del Vecchio; J. Ramos; J. Azevedo; C. Bustamante; A. Oliveira; H. Zaw; H. Kurup; T. Yli-Kyyny; E. Baca; H. Haapasalo; G. Bakhtamyan; P. Zbikowski; J. Kalb; P. Hemmingsson; M. Pinheiro; J. Davenport; P.L. Guidi; A.P. Simoes Da Silva; G. Martinho; P. Spennacchio; Y. Postnov; N. Dreiangel; N.G. Junior; I. Frangez; I. Bissell; Y. Khan; A. Toom; C.V. Bergen; H. Liszka; N. Moreno; B. Patczai; M. Van Den Bogaert; C. Marquis; A.K. Hussein; M. Andersen; L. Botezatu; F.F. Santos; C. Nery; S. Becirbegovc; C.L. Stoffel; P. Ferrao; I. Rakovac; N. Darabos; P. Sicchiero; K. Tengiz; L. Keiserman; E.J. Yeap; A.L. Rocha De Souza; S. Abdulsalam; A. Ramos; N. Martinelli; S. Verfaillie; C. Silva; S. Stufkens; V. Chouliaras; D. Da Costa; R. Freihaut; G. Bulstra; A. Burg; B. Rudge; A. Abdelwahab; A. Sirio; T. Watson; A.R. Gaspar; I. Sharp; M. Hossain; D. Van Deurzen; M. Van Den Bekerom; J.-J. Wiegerinck; I. Van Eekeren; R.-J. De Muinck Keizer

doi:10.1016/j.injury.2015.07.019

Guesstimation of posterior malleolar fractures on lateral plain radiographs

D.T. Meijer, J.N. Doornberg, I.N. Sierevelt, W.H. Mallee, C.N. Van Dijk, G.M. Kerkhoffs, S.A. Stufkens, E. Palmanovich, M. Van Sterkenburg, A. Engvall, E. Arroyo, M. Golovakha, E. Pereira, E.T. Josep Torrent, D. Haverkamp, I. Bojanic, M. Sousa, O.C. Aragon, A. Russo, C. CortesG. Pánics, J. Vide, L. Spanos, M.S. Carvalho, P. Maggi, Z. Thomas, H. Tanaka, M. Dinato, J. Fay, V. Kimtys, A.J. Correia Moreira, D. Hatziemmanuil, T.-C. Low, L.W. Van Der Plaat, A.D. Mora, I. Van Rensen, J. Del Vecchio, J. Ramos, J. Azevedo, C. Bustamante, A. Oliveira, H. Zaw, H. Kurup, T. Yli-Kyyny, E. Baca, H. Haapasalo, G. Bakhtamyan, P. Zbikowski, J. Kalb, P. Hemmingsson, M. Pinheiro, J. Davenport, P.L. Guidi, A.P. Simoes Da Silva, G. Martinho, P. Spennacchio, Y. Postnov, N. Dreiangel, N.G. Junior, I. Frangez, I. Bissell, Y. Khan, A. Toom, C.V. Bergen, H. Liszka, N. Moreno, B. Patczai, M. Van Den Bogaert, C. Marquis, A.K. Hussein, M. Andersen, L. Botezatu, F.F. Santos, C. Nery, S. Becirbegovc, C.L. Stoffel, P. Ferrao, I. Rakovac, N. Darabos, P. Sicchiero, K. Tengiz, L. Keiserman, E.J. Yeap, A.L. Rocha De Souza, S. Abdulsalam, A. Ramos, N. Martinelli, S. Verfaillie, C. Silva, S. Stufkens, V. Chouliaras, D. Da Costa, R. Freihaut, G. Bulstra, A. Burg, B. Rudge, A. Abdelwahab, A. Sirio, T. Watson, A.R. Gaspar, I. Sharp, M. Hossain, D. Van Deurzen, M. Van Den Bekerom, J.-J. Wiegerinck, I. Van Eekeren, R.-J. De Muinck Keizer

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

© 2015 Elsevier Ltd. All rights reserved.Background Accurate assessment of articular involvement of the posterior malleolar fracture fragments in ankle fractures is essential, as this is the leading argument for internal fixation. The purpose of this study is to assess diagnostic accuracy of measurements on plain lateral radiographs. Methods Quantification of three-dimensional computed tomography (Q-3D-CT) was used as a reference standard for true articular involvement (mm2) of posterior malleolar fractures. One-hundred Orthopaedic Trauma surgeons were willing to review 31 trimalleolar ankle fractures to estimate size of posterior malleolus and answer: (1) what is the involved articular surface of the posterior malleolar fracture as a percentage of the tibial plafond? and (2) would you fix the posterior malleolus? Results The average posterior malleolar fragment involved 13.5% (SD 10.8) of the tibial plafond articular surface, as quantified using Q-3D-CT. The average involvement of articular surface of the posterior malleolar fragment, as estimated by 100 observers on plain radiographs was 24.4% (SD 10.0). The factor 1.8 overestimation of articular involvement was statistically significant (p < 0.001). Diagnostic accuracy of measurements on plain lateral radiographs was 22%. Interobserver agreement (ICC) was 0.61. Agreement on operative fixation, showed an ICC of 0.54 (Haraguchi type I = 0.76, Haraguchi type II = 0.40, Haraguchi type III = 0.25). Conclusions Diagnostic accuracy of measurements on plain lateral radiographs to assess articular involvement of posterior malleolar fractures is poor. There is a tendency to misjudge posteromedial involvement (Haraguchi type II).

Original language	English
Pages (from-to)	2024-2029
Journal	Injury
Volume	46
Issue number	10
DOIs	https://doi.org/10.1016/j.injury.2015.07.019
Publication status	Published - 1 Oct 2015
Externally published	Yes

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Meijer, D. T., Doornberg, J. N., Sierevelt, I. N., Mallee, W. H., Van Dijk, C. N., Kerkhoffs, G. M., Stufkens, S. A., Palmanovich, E., Van Sterkenburg, M., Engvall, A., Arroyo, E., Golovakha, M., Pereira, E., Josep Torrent, E. T., Haverkamp, D., Bojanic, I., Sousa, M., Aragon, O. C., Russo, A., ... De Muinck Keizer, R.-J. (2015). Guesstimation of posterior malleolar fractures on lateral plain radiographs. Injury, 46(10), 2024-2029. https://doi.org/10.1016/j.injury.2015.07.019

@article{5aa66861ed884a119785636d24d08f93,

title = "Guesstimation of posterior malleolar fractures on lateral plain radiographs",

abstract = "{\textcopyright} 2015 Elsevier Ltd. All rights reserved.Background Accurate assessment of articular involvement of the posterior malleolar fracture fragments in ankle fractures is essential, as this is the leading argument for internal fixation. The purpose of this study is to assess diagnostic accuracy of measurements on plain lateral radiographs. Methods Quantification of three-dimensional computed tomography (Q-3D-CT) was used as a reference standard for true articular involvement (mm2) of posterior malleolar fractures. One-hundred Orthopaedic Trauma surgeons were willing to review 31 trimalleolar ankle fractures to estimate size of posterior malleolus and answer: (1) what is the involved articular surface of the posterior malleolar fracture as a percentage of the tibial plafond? and (2) would you fix the posterior malleolus? Results The average posterior malleolar fragment involved 13.5% (SD 10.8) of the tibial plafond articular surface, as quantified using Q-3D-CT. The average involvement of articular surface of the posterior malleolar fragment, as estimated by 100 observers on plain radiographs was 24.4% (SD 10.0). The factor 1.8 overestimation of articular involvement was statistically significant (p < 0.001). Diagnostic accuracy of measurements on plain lateral radiographs was 22%. Interobserver agreement (ICC) was 0.61. Agreement on operative fixation, showed an ICC of 0.54 (Haraguchi type I = 0.76, Haraguchi type II = 0.40, Haraguchi type III = 0.25). Conclusions Diagnostic accuracy of measurements on plain lateral radiographs to assess articular involvement of posterior malleolar fractures is poor. There is a tendency to misjudge posteromedial involvement (Haraguchi type II).",

author = "D.T. Meijer and J.N. Doornberg and I.N. Sierevelt and W.H. Mallee and {Van Dijk}, C.N. and G.M. Kerkhoffs and S.A. Stufkens and E. Palmanovich and {Van Sterkenburg}, M. and A. Engvall and E. Arroyo and M. Golovakha and E. Pereira and {Josep Torrent}, E.T. and D. Haverkamp and I. Bojanic and M. Sousa and O.C. Aragon and A. Russo and C. Cortes and G. P{\'a}nics and J. Vide and L. Spanos and M.S. Carvalho and P. Maggi and Z. Thomas and H. Tanaka and M. Dinato and J. Fay and V. Kimtys and {Correia Moreira}, A.J. and D. Hatziemmanuil and T.-C. Low and {Van Der Plaat}, L.W. and A.D. Mora and {Van Rensen}, I. and {Del Vecchio}, J. and J. Ramos and J. Azevedo and C. Bustamante and A. Oliveira and H. Zaw and H. Kurup and T. Yli-Kyyny and E. Baca and H. Haapasalo and G. Bakhtamyan and P. Zbikowski and J. Kalb and P. Hemmingsson and M. Pinheiro and J. Davenport and P.L. Guidi and {Simoes Da Silva}, A.P. and G. Martinho and P. Spennacchio and Y. Postnov and N. Dreiangel and N.G. Junior and I. Frangez and I. Bissell and Y. Khan and A. Toom and C.V. Bergen and H. Liszka and N. Moreno and B. Patczai and {Van Den Bogaert}, M. and C. Marquis and A.K. Hussein and M. Andersen and L. Botezatu and F.F. Santos and C. Nery and S. Becirbegovc and C.L. Stoffel and P. Ferrao and I. Rakovac and N. Darabos and P. Sicchiero and K. Tengiz and L. Keiserman and E.J. Yeap and {Rocha De Souza}, A.L. and S. Abdulsalam and A. Ramos and N. Martinelli and S. Verfaillie and C. Silva and S. Stufkens and V. Chouliaras and {Da Costa}, D. and R. Freihaut and G. Bulstra and A. Burg and B. Rudge and A. Abdelwahab and A. Sirio and T. Watson and A.R. Gaspar and I. Sharp and M. Hossain and {Van Deurzen}, D. and {Van Den Bekerom}, M. and J.-J. Wiegerinck and {Van Eekeren}, I. and {De Muinck Keizer}, R.-J.",

year = "2015",

month = oct,

day = "1",

doi = "10.1016/j.injury.2015.07.019",

language = "English",

volume = "46",

pages = "2024--2029",

journal = "Injury",

issn = "0020-1383",

publisher = "Elsevier Limited",

number = "10",

}

Meijer, DT, Doornberg, JN, Sierevelt, IN, Mallee, WH, Van Dijk, CN, Kerkhoffs, GM, Stufkens, SA, Palmanovich, E, Van Sterkenburg, M, Engvall, A, Arroyo, E, Golovakha, M, Pereira, E, Josep Torrent, ET, Haverkamp, D, Bojanic, I, Sousa, M, Aragon, OC, Russo, A, Cortes, C, Pánics, G, Vide, J, Spanos, L, Carvalho, MS, Maggi, P, Thomas, Z, Tanaka, H, Dinato, M, Fay, J, Kimtys, V, Correia Moreira, AJ, Hatziemmanuil, D, Low, T-C, Van Der Plaat, LW, Mora, AD, Van Rensen, I, Del Vecchio, J, Ramos, J, Azevedo, J, Bustamante, C, Oliveira, A, Zaw, H, Kurup, H, Yli-Kyyny, T, Baca, E, Haapasalo, H, Bakhtamyan, G, Zbikowski, P, Kalb, J, Hemmingsson, P, Pinheiro, M, Davenport, J, Guidi, PL, Simoes Da Silva, AP, Martinho, G, Spennacchio, P, Postnov, Y, Dreiangel, N, Junior, NG, Frangez, I, Bissell, I, Khan, Y, Toom, A, Bergen, CV, Liszka, H, Moreno, N, Patczai, B, Van Den Bogaert, M, Marquis, C, Hussein, AK, Andersen, M, Botezatu, L, Santos, FF, Nery, C, Becirbegovc, S, Stoffel, CL, Ferrao, P, Rakovac, I, Darabos, N, Sicchiero, P, Tengiz, K, Keiserman, L, Yeap, EJ, Rocha De Souza, AL, Abdulsalam, S, Ramos, A, Martinelli, N, Verfaillie, S, Silva, C, Stufkens, S, Chouliaras, V, Da Costa, D, Freihaut, R, Bulstra, G, Burg, A, Rudge, B, Abdelwahab, A, Sirio, A, Watson, T, Gaspar, AR, Sharp, I, Hossain, M, Van Deurzen, D, Van Den Bekerom, M, Wiegerinck, J-J, Van Eekeren, I & De Muinck Keizer, R-J 2015, 'Guesstimation of posterior malleolar fractures on lateral plain radiographs', Injury, vol. 46, no. 10, pp. 2024-2029. https://doi.org/10.1016/j.injury.2015.07.019

TY - JOUR

T1 - Guesstimation of posterior malleolar fractures on lateral plain radiographs

AU - Meijer, D.T.

AU - Doornberg, J.N.

AU - Sierevelt, I.N.

AU - Mallee, W.H.

AU - Van Dijk, C.N.

AU - Kerkhoffs, G.M.

AU - Stufkens, S.A.

AU - Palmanovich, E.

AU - Van Sterkenburg, M.

AU - Engvall, A.

AU - Arroyo, E.

AU - Golovakha, M.

AU - Pereira, E.

AU - Josep Torrent, E.T.

AU - Haverkamp, D.

AU - Bojanic, I.

AU - Sousa, M.

AU - Aragon, O.C.

AU - Russo, A.

AU - Cortes, C.

AU - Pánics, G.

AU - Vide, J.

AU - Spanos, L.

AU - Carvalho, M.S.

AU - Maggi, P.

AU - Thomas, Z.

AU - Tanaka, H.

AU - Dinato, M.

AU - Fay, J.

AU - Kimtys, V.

AU - Correia Moreira, A.J.

AU - Hatziemmanuil, D.

AU - Low, T.-C.

AU - Van Der Plaat, L.W.

AU - Mora, A.D.

AU - Van Rensen, I.

AU - Del Vecchio, J.

AU - Ramos, J.

AU - Azevedo, J.

AU - Bustamante, C.

AU - Oliveira, A.

AU - Zaw, H.

AU - Kurup, H.

AU - Yli-Kyyny, T.

AU - Baca, E.

AU - Haapasalo, H.

AU - Bakhtamyan, G.

AU - Zbikowski, P.

AU - Kalb, J.

AU - Hemmingsson, P.

AU - Pinheiro, M.

AU - Davenport, J.

AU - Guidi, P.L.

AU - Simoes Da Silva, A.P.

AU - Martinho, G.

AU - Spennacchio, P.

AU - Postnov, Y.

AU - Dreiangel, N.

AU - Junior, N.G.

AU - Frangez, I.

AU - Bissell, I.

AU - Khan, Y.

AU - Toom, A.

AU - Bergen, C.V.

AU - Liszka, H.

AU - Moreno, N.

AU - Patczai, B.

AU - Van Den Bogaert, M.

AU - Marquis, C.

AU - Hussein, A.K.

AU - Andersen, M.

AU - Botezatu, L.

AU - Santos, F.F.

AU - Nery, C.

AU - Becirbegovc, S.

AU - Stoffel, C.L.

AU - Ferrao, P.

AU - Rakovac, I.

AU - Darabos, N.

AU - Sicchiero, P.

AU - Tengiz, K.

AU - Keiserman, L.

AU - Yeap, E.J.

AU - Rocha De Souza, A.L.

AU - Abdulsalam, S.

AU - Ramos, A.

AU - Martinelli, N.

AU - Verfaillie, S.

AU - Silva, C.

AU - Stufkens, S.

AU - Chouliaras, V.

AU - Da Costa, D.

AU - Freihaut, R.

AU - Bulstra, G.

AU - Burg, A.

AU - Rudge, B.

AU - Abdelwahab, A.

AU - Sirio, A.

AU - Watson, T.

AU - Gaspar, A.R.

AU - Sharp, I.

AU - Hossain, M.

AU - Van Deurzen, D.

AU - Van Den Bekerom, M.

AU - Wiegerinck, J.-J.

AU - Van Eekeren, I.

AU - De Muinck Keizer, R.-J.

PY - 2015/10/1

Y1 - 2015/10/1

N2 - © 2015 Elsevier Ltd. All rights reserved.Background Accurate assessment of articular involvement of the posterior malleolar fracture fragments in ankle fractures is essential, as this is the leading argument for internal fixation. The purpose of this study is to assess diagnostic accuracy of measurements on plain lateral radiographs. Methods Quantification of three-dimensional computed tomography (Q-3D-CT) was used as a reference standard for true articular involvement (mm2) of posterior malleolar fractures. One-hundred Orthopaedic Trauma surgeons were willing to review 31 trimalleolar ankle fractures to estimate size of posterior malleolus and answer: (1) what is the involved articular surface of the posterior malleolar fracture as a percentage of the tibial plafond? and (2) would you fix the posterior malleolus? Results The average posterior malleolar fragment involved 13.5% (SD 10.8) of the tibial plafond articular surface, as quantified using Q-3D-CT. The average involvement of articular surface of the posterior malleolar fragment, as estimated by 100 observers on plain radiographs was 24.4% (SD 10.0). The factor 1.8 overestimation of articular involvement was statistically significant (p < 0.001). Diagnostic accuracy of measurements on plain lateral radiographs was 22%. Interobserver agreement (ICC) was 0.61. Agreement on operative fixation, showed an ICC of 0.54 (Haraguchi type I = 0.76, Haraguchi type II = 0.40, Haraguchi type III = 0.25). Conclusions Diagnostic accuracy of measurements on plain lateral radiographs to assess articular involvement of posterior malleolar fractures is poor. There is a tendency to misjudge posteromedial involvement (Haraguchi type II).

AB - © 2015 Elsevier Ltd. All rights reserved.Background Accurate assessment of articular involvement of the posterior malleolar fracture fragments in ankle fractures is essential, as this is the leading argument for internal fixation. The purpose of this study is to assess diagnostic accuracy of measurements on plain lateral radiographs. Methods Quantification of three-dimensional computed tomography (Q-3D-CT) was used as a reference standard for true articular involvement (mm2) of posterior malleolar fractures. One-hundred Orthopaedic Trauma surgeons were willing to review 31 trimalleolar ankle fractures to estimate size of posterior malleolus and answer: (1) what is the involved articular surface of the posterior malleolar fracture as a percentage of the tibial plafond? and (2) would you fix the posterior malleolus? Results The average posterior malleolar fragment involved 13.5% (SD 10.8) of the tibial plafond articular surface, as quantified using Q-3D-CT. The average involvement of articular surface of the posterior malleolar fragment, as estimated by 100 observers on plain radiographs was 24.4% (SD 10.0). The factor 1.8 overestimation of articular involvement was statistically significant (p < 0.001). Diagnostic accuracy of measurements on plain lateral radiographs was 22%. Interobserver agreement (ICC) was 0.61. Agreement on operative fixation, showed an ICC of 0.54 (Haraguchi type I = 0.76, Haraguchi type II = 0.40, Haraguchi type III = 0.25). Conclusions Diagnostic accuracy of measurements on plain lateral radiographs to assess articular involvement of posterior malleolar fractures is poor. There is a tendency to misjudge posteromedial involvement (Haraguchi type II).

U2 - 10.1016/j.injury.2015.07.019

DO - 10.1016/j.injury.2015.07.019

M3 - Article

SN - 0020-1383

VL - 46

SP - 2024

EP - 2029

JO - Injury

JF - Injury

IS - 10

ER -

Guesstimation of posterior malleolar fractures on lateral plain radiographs

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