Le suivi radiographique des fractures isolées du tubercule majeur huméral conduit-il à un changement des recommandations thérapeutiques ? Résultats d'une enquête en ligne

Introduction: It is common practice to obtain follow-up radiographs of non-operatively treated isolated greater tuberosity (GT) fractures 1 to 2 weeks after trauma. However, the majority of non-operatively treated GT fractures remain stable and do not require reconsideration of the initial treatment decision. Radiological follow-up therefore might be unnecessary. Our primary objective was to study whether radiological follow-up changes the initial treatment recommendation, hypothesizing no change. Materials and methods: Radiographs of 25 patients diagnosed with an isolated GT fracture were selected from our hospital database and presented on a web-based platform. Sixty-eight trauma- and orthopedic surgeons evaluated these radiographs. First, the radiographs directly post-trauma and then, in random order, the radiographs 5–14 days post-trauma alongside the first radiographs. Each observer evaluated each set of radiographs once. The observers answered which treatment they would recommend (non-operative/operative), and how certain they were about their advice (absolutely certain, certain, some doubt, very uncertain). Recommendation-consistency and inter-observer agreement are presented as percentages and intra class correlation coefficients (ICC). Results: Overall, 84 % (95 % CI 82.1–85.8) of treatment recommendations was unchanged after evaluation of the second radiograph. Agreement within each observer ranged from 60 to 98 %. The mean proportion of patients about whom the observers were (absolutely) certain of their recommendation increased from 70 % at the first evaluation to 83 % at the second evaluation (12.8; 95 % CI 9.8–15.9). Furthermore, the ICC between the surgeons improved from 0.37 (95 % CI 0.26–0.54) for the first evaluation to 0.60 (95 % CI 0.47–0.74) for the second. Conclusion: In 16 % of the patients, the treatment recommendation for an isolated GT fracture changed after the evaluation of radiographs 1 to 2 weeks post-trauma. In addition, surgeons were more certain about their recommendation and there was less inter-observer variation. Radiological follow-up of a non-operatively treated isolated GT fracture therefore seems justifiable. Level of evidence: III, diagnostic study.