Abstract
Purpose
To determine the interobserver reliability of perceived displacement (PD) ≥ 1 cm of lateral compression type 1 (LC1) pelvic ring fractures and to determine if PD correlated with published methods of measuring fracture displacement and adverse events.
Methods
The injury and follow-up radiographs of 10 patients with nonoperative minimally displaced LC1 injuries were reviewed by 27 orthopaedic trauma surgeons to determine if they perceived an interval fracture displacement ≥ 1 cm. Perceived displacement (PD) was compared to 11 measurements of displacement: the difference in heights of iliac crests (IC), sourcils, and ischial tuberosities on AP/outlet radiographs; the distance from femoral head (FH) to the sacral midline and the distance between the radiographic teardrops (TD) on the AP; the distance from the TD to sacral midline and the difference in distances between the SI joints and the contralateral TD on the inlet. The interobserver reliability and correlation of PD and measured displacement was calculated. The association between PD and adverse events was also evaluated.
Results
PD had weak interobserver reliability (kappa = 0.46). Many of the measurements of displacement were poorly sensitive for PD. The magnification-corrected AP TD measurement had the highest sensitivity (100%) for PD and excellent interobserver reliability (Intraclass correlation 0.97), but had a low specificity (57.1%). All three patients with PD had adverse events while patients without PD had uneventful recoveries (p = 0.008).
Conclusions
The AP TD measurement detected all cases of PD and had excellent reliability. PD was associated with adverse events, suggesting that accurate and reliable measurements of displacement are warranted.
Level of evidence III
Diagnostic.
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Change history
04 February 2024
A Correction to this paper has been published: https://doi.org/10.1007/s00590-023-03827-0
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Acknowledgments
The Orthopaedic Trauma Research (OTR) Group: Augustine Saiz, Department of Orthopaedics, University of California Davis, Sacramento, CA, USA; Chris Lee, Department of Orthopaedics, University of California Los Angeles, Los Angeles, CA, USA; Graham DeKeyser, Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA; John Morellato, Department of Orthopaedics, University of Mississippi Medical Center, Jackson, MS, USA; Joseph Patterson, Department of Orthopaedics, University of Southern California Keck School of Medicine, Los Angeles, CA, USA; Joshua Alan Parry, MD, MSc, Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO, USA; Justin Haller, Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA; Lucas Marchand, Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA; Matthew Wharton, Department of Orthopaedics, University of New Mexico, Albuquerque, NM, USA; Nicholas Tucker, MD, Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO, USA; Patrick Kellam, Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA; Stephen Shymon, Department of Orthopaedics, Harbor-University of California Los Angeles, Los Angeles, CA, USA; Stephen Warner, Department of Orthopaedics, University of Texas at Houston Medical Center, Houston, TX, USA; Yejoon Kim, MD, Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO, USA; Zachary Working, Department of Orthopaedics, University of Oregon Health Science Center, Portland, OR, USA.
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The Orthopaedic Trauma Research (OTR) Group. Fracture displacement of lateral compression type 1 (LC1) Pelvic Ring Injuries: Which measurement methods are reliable and does displacement correlate with adverse events?. Eur J Orthop Surg Traumatol (2023). https://doi.org/10.1007/s00590-023-03776-8
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DOI: https://doi.org/10.1007/s00590-023-03776-8