• 1

    Mann DC, Rajmaira S: Distribution of physeal and nonphyseal fractures in 2650 long-bone fractures in children aged 0–16 years. J Pediatr Orthop 10: 713, 1990.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Salter RB, Harris WR: Injuries involving the epiphyseal plate. J Bone Joint Surg Am 45: 587, 1963.

  • 3

    Cai H, Wang Z, Cai H: Surgical indications for distal tibial epiphyseal fractures in children. Orthopedics 38: e189, 2015.

  • 4

    Crawford AH: Triplane and Tillaux fractures: is a 2 mm residual gap acceptable? J Pediatr Orthop 32(suppl 1): 69, 2012.

  • 5

    Leary JT, Handling M, Talerico M, et al.: Physeal fractures of the distal tibia: predictive factors of premature physeal closure and growth arrest. J Pediatr Orthop 29: 356, 2009.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Poyanli O, Unay K, Akan K, et al.: Distal tibial epiphyseal fracture (Tillaux) and capsular interposition. JAPMA 99: 435, 2009.

  • 7

    Cole RJ, Bindra RR, Evanoff BA, et al.: Radiographic evaluation of osseous displacement following intra-articular fractures of the distal radius: reliability of plain radiography versus computed tomography. J Hand Surg 22:792, 1997.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Borrelli J Jr, Goldfarb C, Catalano L, et al.: Assessment of articular fragment displacement in acetabular fractures: a comparison of computerized tomography and plain radiographs. J Orthop Trauma 16: 449, 2002.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Drynan D, McArthur M, Vohora A, et al.: Accuracy of digital radiography: regional scaling factors for trauma. ANZ J Surg 88: 341, 2018.

  • 10

    King RJ, Craig PR, Boreham BG, et al.: The magnification of digital radiographs in the trauma patient: implications for templating. Injury 40: 173, 2009.

  • 11

    Eismann EA, Stephan ZA, Mehlman CT, et al.: Pediatric triplane ankle fractures: impact of radiographs and computed tomography on fracture classification and treatment planning. J Bone Joint Surg Am 97: 995, 2015.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Landis JR, Koch GG: The measurement of observer agreement for categorical data. Biometrics 33: 159, 1977.

  • 13

    Fleiss JL: Statistical Methods for Rates and Proportions, 2nd ed, John Wiley & Sons, New York, 1981.

  • 14

    Catalano LW III, Barron OA, Glickel SZ: Assessment of articular displacement of distal radius fractures. Clin Orthop Relat Res 423: 79, 2004.

  • 15

    Bozentka DJ, Beredjiklian PK, Westawski D, et al.: Digital radiographs in the assessment of distal radius fracture parameters. Clin Orthop Relat Res 397: 409, 2002.

  • 16

    Arora S, Grover SB, Batra S, et al.: Comparative evaluation of postreduction intra-articular distal radial fractures by radiographs and multidetector computed tomography. J Bone Joint Surg Am 92: 2523, 2010.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    El Emam K: Benchmarking kappa: interrater agreement in software process assessments. Empir Softw Eng 4: 113, 1999.

How Reliable Are Digital Radiographs for Evaluating Intra-articular Displacement in Ankle Epiphyseal Fractures: Can Computed Tomography Be Eliminated?

Ali Turgut Department of Orthopedics, University of Health Sciences Tepecik Training and Research Hospital, Yenisehir, İzmir, Turkey.

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Anıl Koca Department of Orthopedics, University of Health Sciences Tepecik Training and Research Hospital, Yenisehir, İzmir, Turkey.

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Melikşah Uzakgider Department of Orthopedics, University of Health Sciences Tepecik Training and Research Hospital, Yenisehir, İzmir, Turkey.

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Ümit Altundağ Department of Orthopedics, University of Health Sciences Tepecik Training and Research Hospital, Yenisehir, İzmir, Turkey.

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Mehmet Can Gezer Department of Orthopedics, University of Health Sciences Tepecik Training and Research Hospital, Yenisehir, İzmir, Turkey.

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Onder Kalenderer Department of Orthopedics, University of Health Sciences Tepecik Training and Research Hospital, Yenisehir, İzmir, Turkey.

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Background: The amount of intra-articular displacement of the fracture is the main issue when deciding the treatment method between conservative or surgical means in intra-articular fractures. In this study, we aimed to determine the intraobserver and interobserver reliability of measuring intra-articular displacement and to compare the digital radiographic and computed tomographic (CT) evaluations in distal tibia intra-articular epiphyseal fractures.

Methods: Thirty-seven patients with digital radiography and CT scans were included in the study. Four sets were prepared with these images. Two of four sets were prepared as ankle radiographs, and the other two sets were prepared with CT scan views. Five observers were asked to measure the intra-articular displacement of the fractures in millimeters and also to make a decision between displacement amounts over or under 2 mm. Intraclass correlation coefficient scores were calculated for evaluation of intraobserver reliability, and Fleiss kappa values were calculated for interobserver reliability evaluations. A value greater than 0.75 was accepted as excellent agreement; 0.75 to 0.40 as intermediate to good agreement; and below 0.40 as poor agreement.

Results: There were 15 Salter-Harris type 3, 13 Salter-Harris type 4, seven triplanar, and two Tillaux-Chaput fractures. Both intraobserver and interobserver reliabilities were slightly higher for CT scan evaluations. Amounts of displacement were found to be measured higher after CT scan evaluations other than radiographs. After the measurement of joint displacements on CT scans, it was observed that the measurements found below 2 mm on the digital radiograph measurement changed to greater than or equal to 2 mm in 16.4% of the patients.

Conclusions: This study confirmed that digital radiographs cannot replace CT scans for the measurement of intra-articular displacement in ankle epiphyseal fractures.

Corresponding author: Ali Turgut, MD, Department of Orthopedics, University of Health Sciences Tepecik Training and Research Hospital, Yenisehir, İzmir, 35530, Turkey. (E-mail: draliturgutort@yahoo.com.tr)
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