Interobserver and intraobserver agreement for Letournel acetabular fracture classification system using 3-dimensional printed solid models

BACKGROUND Acetabular fractures pose diagnostic and surgical challenges.They are classified using the Judet-Letournel system,which is based solely on X-ray.However,computed tomography(CT)imaging is now more widely utilized in diagnosing these injuries.The emergence of 3-dimensional(3-D)printing technology in varying orthopedic fields has provided surgeons a solid model that improves their spatial understanding of complex fractures and ability to plan preoperatively.AIM To evaluate the reliability of the Judet-Letournel classification system of acetabular fractures,when using either CT imaging or 3-D printed models.METHODS Seven patients with acetabular fractures underwent pelvic CT imaging,which was then used to create solid,3-D printed models.Eighteen orthopaedic trauma surgeons responded to questionnaires regarding fracture classification and preferred surgical approach.The same questionnaire was completed using only CT imaging,and two weeks later,using only 3-D printed models.The inter-and intra-observer agreement rates were then analyzed.RESULTS Inter-observer agreement rates based on CT imaging or 3-D printed models were moderate for fracture classification:κ=0.44,κ=0.55,respectively(P<0.001)and fair for preferred surgical approach:κ=0.34,κ=0.29,respectively(P<0.005).Intra-observer agreement rates for fracture classification and preferred surgical approach comparing CT imaging or 3-D printed models were moderate:κ=0.48,κ=0.41,respectively.No significant difference in intra-observer agreement was detected when comparing orthopedic pelvic specialists to general orthopedic traumatologists.CONCLUSION The Judet-Letournel classification demonstrated only moderate rates of agreement.The use of 3-D printed models increased the inter-observer agreement rates with respect to fracture classification,but decreased it with respect to the preferred surgical approach.This study highlights the role of 3-D printed models in acetabular fractures by improving spatial understanding of these complex injuries,thus providing more reliable fracture diagnoses and alternative viewpoints for pre-operative planning.

The diagnostic value of the shoulder rotator cuff muscles’ isometric force testing

The most prevalent group of disorders of human shoulder is related to the muscles of the rotator cuff. In order to develop a mechanical method for rotator cuff muscles’ evaluation, we hypothesized that measurement of the isometric force generated by the individual muscle of the rotator cuff might detect the variations, which are characteristic to the different disorders of rotator cuff muscles in adults. The isometric force of supraspinatus, infraspinatus and subscapularis muscles were measured in patients with rotator cuff tears, calcific tendinitis and subacromial impingement syndrome, 30 patients with each disorder, and compared to the normal values from our previous study. Torque of the force was calculated and normalized to lean body mass. The profiles of the mean torque-time curves of each group were compared statistically. We found the expected significantly lower profiles of the torque-time curves of all the tested rotator cuff muscles in comparison to the normal values. The best resolution between the curves of different study groups was found in the testing of the infraspinatus muscles. Therefore the previously unrecognized variations of rotator cuff muscles’ isometric strength build up patterns in the common disorders involving the rotator cuff muscles were revealed. The presented data might be a basis for the future development of a simple mechanical diagnostic method for identification of the abnormal patterns of muscle isometric strength in patients with rotator cuff muscles’ pathology.

Predictors for Adverse Outcome in Patients Aged 80 Years and Older Undergoing Emergent Hip Surgery

Background: Increased life expectancy results in aging of the population. One of the leading medical problems of elderly patients is hip fracture. We studied demographic, surgical and anesthetic parameters of elderly patients who underwent surgery due to osteoporotic hip fracture, to find predictors for peri-operative morbidity and mortality. Methods: This is a retrospective review of prospectively collected data of patients aged 80 years and older who underwent emergent surgery due to osteoporotic femoral neck, subcapital or pertrochanteric fractures. Data was collected on age, gender, co-morbidities, American Society of Anesthesiologists Class, number of regular medications, whether the patient was bedridden or not before the surgery, hemoglobin on admission and on discharge, type of surgery and anesthesia, duration of surgery, duration of hospitalization, post-operative morbidity and mortality. The demographic and peri-operative parameters were analyzed and matched to the post-operative complications and mortality to find predictors for adverse outcome. Results: One hundred and nine patients were included in the study, of whom 22 (20%) had post-operative complications and 10 (9.1%) died. We found an increased complication rate in patients who had chronic obstructive pulmonary disease and in patients who underwent general anesthesia. Patients who were bedridden before the surgery had increased mortality rates. No significant correlation was found between outcome and any other factors. Conclusion: Our results suggest favoring regional anesthesia in elderly patients undergoing emergent femoral neck surgery and acknowledging a higher risk in chronic pulmonary disease or bedridden patients.