Evaluation of ankle conventional x-ray as a gold standard on diagnosis and treatment decisions for ankle weber B fractures. Self-controlled multicentric experiment
DOI:
https://doi.org/10.1016/j.rccot.2020.07.002Keywords:
ankle fractures, Weber B, radiography, diagnostic test, surgical decisionAbstract
Background: Ankle fractures are one of the main causes of consultation with emergency services around the world, with an incidence of 187 / 100,000 inhabitants per year. The most common is type B in the Weber classification, with a long-term evolution towards osteoarthritis of 14%. Although the diagnosis of distal fibular fracture on an ankle radiograph is very simple, its usefulness has probably been overestimated to provide the necessary insights to decide the appropriate treatment method for the fracture. The objective of the study is to evaluate the diagnostic utility of ankle radiographs and their inter-observer agreement for the treatment decision making in Weber B fractures.
Methods: A prospective, randomized, double-blind, multicenter trial using three-country surveys of orthopedic surgeons was conducted; orthopedic surgeons and foot and ankle surgeons, were exposed to four Weber B ankle fractures x-ray series where surgery was actually required as the only treatment option. Unilateral and comparative projections, where presented in different time and order to each surgeon, measuring the variability of surgical decisions.
Results: Fifty-one orthopedic surgeons (72.37%), 24 foot and ankle surgeons (15.79%), 4 surgeons of other orthopedic subspecialties (2.63%) and 14 orthopedic surgery residents (9.21%) were surveyed. An inter-observer agreement of 70.83% (p < 0.05) was found in the comparative projections series and 55.31% (p < 0.05) in the unilateral ones. When performing linear regression between the training degree, years of experience and the provenance country of the surgeons, no causality was found (power of < 95%). Nevertheless, 100% of the respondents diagnosed the fracture of the distal fibula as a Weber B fracture.
Discussion: The unilateral and comparative radiographic series are not recommended for making an adequate surgical decision in Weber B ankle fractures, given their very low interobserver agreement. For decision making in Weber B ankle fractures it is necessary to take other complementary examinations such as Computed Axial Tomography.
Evidence Level: II
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