|
Back to 2017 Scientific Program ePosters
Does Substantial Variation Exist When Diagnosing and Treating Pediatric Distal Radius Fractures
Karan Dua, MD1; Matthew K. Stein, BS1, Nathan O'Hara, MHA1, Brian K. Brighton, MD, MPH2; William L. Hennrikus, MD3; Martin J. Herman, MD4; J. Todd Lawrence, MD, PhD5; Charles T. Mehlman, DO, MPH6; Norman Y. Otsuka, MD7; M. Wade Shrader, MD8; Brian G. Smith, MD9; Paul D. Sponseller, MD, MBA10; Joshua M. Abzug, MD1
1University of Maryland School of Medicine, Baltimore, MD, 2Carolinas Healthcare System/Levine Children’s Hospital, Charlotte, NC, 3Penn State Hershey Medical Center, Hershey, PA, 4Orthopaedics, St. Christopher's Hospital for Children, Philadelphia, PA, 5Children's Hospital of Philadelphia, Wynnewood, PA, 6University of Cincinnati College of Medicine, Cincinnati, OH, 7The Children’s Hospital at Montefiore, Bronx, NY, 8Children’s of Mississippi, Jackson, MS, 9Yale School of Medicine, New Haven, CT, 10Johns Hopkins University, Baltimore, MD
Introduction: Distal radius fractures are the most common injury in the pediatric population. The purpose of this study was to determine the variation when diagnosing and treating distal radius fractures.
Materials and Methods: Nine orthopaedic surgeons reviewed 100 sets of posteroanterior and lateral pediatric wrist radiographs. Surgeons were asked to describe the fracture, prescribe the type of treatment and length of immobilization, and determine the next follow-up visit at which time new radiographs would be obtained to examine fracture healing. Kappa statistics were performed to assess the agreement amongst examiners with the chance agreement removed. Strength of agreement was determined based on guidelines outlined by Landis and Koch. Kappa values of <0.00 were considered poor agreement, 0.00 to 0.20 slight agreement, 0.21 to 0.40 fair agreement, 0.41 to 0.60 moderate agreement, 0.61 to 0.80 substantial agreement, and 0.81 to 1.00 almost perfect agreement.
Results: Only fair agreement was present when diagnosing and classifying the distal radius fractures (k = 0.379). Diagnoses included torus, greenstick, Salter-Harris II, and extra-physeal fractures. There was poor agreement regarding the type of treatment that would be recommended (k = .059). There was no agreement regarding the length of immobilization (k = - .004). Poor agreement was also present regarding when the first follow-up visit should occur (K = .088), whether or not new radiographs should be obtained at the first follow-up visit (k = .133), and if radiographs were necessary at the final follow-up visit (k = .163). Surgeons had fair agreement regarding stability of the fracture (k = .320). A subgroup analysis was performed on radiographs that had perfect agreement on the diagnosis of a torus/buckle fracture. 23 of the 100 radiographs were diagnosed as a torus/buckle fracture by all nine surgeons. Kappa analysis was performed on all the treatment and management questions and each query had poor agreement. Upon closer analysis, it was noted that 33% (3/9) of the surgeons followed an individualized treatment algorithm for torus/buckle fractures.
Conclusion: The inter-observer reliability of diagnosing pediatric distal radius fractures showed only fair agreement. This study demonstrates that there is no standardization regarding how to treat these fractures and the length of immobilization required for proper fracture healing. Better classification systems of pediatric distal radius fractures are needed that standardize the treatment of these injuries in order to provide optimal outcomes with the least patient morbidity and medical cost.
Back to 2017 Scientific Program ePosters
|
|
