Effect of Computerized Tomography on Assessment and Surgical Planning for Olecranon Fractures.

Abstract

1) Determine effects of computed tomography (CT) on reproducibility of olecranon fracture classification. 2) Determine effects of CT utilization on inter-observer agreement regarding management of olecranon fractures. 3) Evaluate factors associated with articular impaction. Seven surgeons retrospectively evaluated radiographs of 46 olecranon fractures. Each fracture was classified according to Colton, Mayo, OTA/AO systems. Observers determined if articular impaction was present and provided treatment plans. This was repeated at minimum six weeks with addition of CT. Descriptive and comparative statistics were performed and intra-class correlation coefficients (ICC) calculated. Inter-rater agreement was near-perfect for all classifications using radiographs (ICC 0.91, 0.93, 0.89 for Colton, Mayo, OTA/AO) and did not substantially change with CT (ICC 0.91, 0.91, 0.93). Agreement was moderate regarding articular impaction using radiographs (ICC 0.44); this improved significantly with CT (ICC 0.82). Articular impaction was significantly associated with OTA/AO classification, with high prevalence of impaction in OTA/AO 2U1B1e (p<0.03). Agreement was substantial for chosen fixation construct using radiographs (ICC 0.71); this improved with CT (ICC 0.79). Utilization of CT changed fixation plans in 25% of cases. Agreement regarding need for void filler was fair using radiographs (ICC 0.37); this notably improved with CT (ICC 0.64). Utilization of CT for evaluating olecranon fractures led to significant improvements in inter-observer agreement for presence of articular impaction. Impaction was significantly associated with fracture pattern but not with patient-related factors. Addition of CT improved agreement regarding fixation construct and led to notable improvement in agreement regarding need for void filler. Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.