Good Intraobserver Reliability Research Articles

Validation of the visual body image classification in adolescent idiopathic scoliosis: a retrospective study.

A prospective study. To diagnose scoliosis, a visit to the hospital for radiography is typically necessary. In such cases, children with scoliosis are exposed to radiation, which may place their health at risk. Therefore, we sought to determine whether a classification method based on visual body images obtained through photography can be used to diagnose scoliosis. Scoliosis can be diagnosed and classified into various types using radiographs. However, no studies have attempted to classify scoliosis based on visual body images. From January 1, 2019 to December 31, 2022, 136 patients newly diagnosed with Adolescent idiopathic scoliosis and 124 healthy candidates from our institution were enrolled. This study classified body images into five types based on visual confirmation of the positional relationship of the body. The accuracy of this classification method was identified by calculating its sensitivity, specificity, and reproducibility of this classification method within and between observers according to kappa value. Overall, 136 patients and 124 control subjects who visited Pusan National University Hospital, Busan, Korea were photographed and compared by obtaining back images and X-ray radiographs. The sensitivity and specificity of the classification method showed a satisfactory-to-good degree of accuracy, although the degree varies depending on the visual body image type. The classification methods exhibited good intraobserver reliability (κ=0.855) and moderate interobserver reliability (κ=0.751). Our classification method showed a high degree of sensitivity and specificity (98.1% sensitivity, 98.9% specificity, and 98.4% accuracy) while exhibiting high reproducibility and ease of access. Based on our findings, we believe that our classification method can be used for scoliosis screening.

Validity and reliability of the osteoporotic fracture treatment score (OF score) and outcomes across various treatments in osteoporosis vertebral compression fracture patients

BackgroundOsteoporotic vertebral compression fractures (OVF) are prevalent and substantially impact healthcare systems and patients’ quality of life. The osteoporotic fracture treatment score (OF score), developed by the German Society of Orthopedics and Trauma (DGOU), guides surgical decisions, but its reliability and validity are underexplored. This study assessed the OF score’s inter- and intraobserver reliability, validated its treatment recommendations, and investigated intermediate outcomes of different DGOU-recommended surgical strategies for OVF.MethodsA retrospective cohort study was conducted. Inter- and intraobserver reliability of the OF score and its subcomponents were analyzed using clinical and radiographic data. Validity was assessed by comparing the OF score’s recommended treatments with actual treatments received. Outcomes at the final follow-up were back pain visual analog scale, Oswestry Disability Index, EQ-VAS, EQ-5D-5 L, adjacent fracture incidence, local kyphotic angle, and reoperation rates. Patients with at least 1-year follow-up were included.ResultsA total of 157 patients (84.7% female; mean age 74.2 ± 10.5 years) were evaluated. The most frequent osteoporotic fracture (OF) types were OF4 (49.0%) and OF3 (40.8%). The OF score demonstrated good interobserver reliability (ICC = 0.77, 95% CI: 0.65–0.86) and intraobserver reliability (ICC = 0.83, 95% CI: 0.72–0.90). Kappa values for subcomponents ranged from 0.57 to 0.89. Excluding patients with indeterminate recommendations (OF score = 6), 82.9% received treatments concordant with OF score recommendations. Receiver operating characteristic curve analysis showed an area under the curve of 0.77 (95% CI: 0.67–0.86); an OF score cutoff > 6.5 predicted actual treatment with 87.9% sensitivity and 61.0% specificity. All surgical treatments showed comparable improvements in clinical outcomes. However, patients treated with stand-alone cement augmentation (CA) had less local kyphotic angle correction (P = 0.004) and greater postoperative kyphotic progression (P < 0.001) than those undergoing short-segment (SS-PI) or long-segment instrumentation (LS-PI). No significant differences in adjacent fractures or complications were observed.ConclusionsThe OF score is a reliable and valid system with good discriminative ability for surgical decision-making in OVF patients. CA, SS-PI, and LS-PI are viable options with comparable functional outcomes. However, in OF3 or OF4 fractures, caution is advised due to lesser kyphosis correction and greater kyphotic progression with CA compared to SS-PI or LS-PI, as recommended by the DGOU.

Echocardiographic markers at diagnosis of persistent pulmonary hypertension of the newborn.

Clinical parameters along with echocardiographic markers are used to interrogate the haemodynamics in persistent pulmonary hypertension of the newborn (PPHN). The aim of this study was to compare different echocardiographic markers in recent cohort of newborn infants with and without PPHN. In this retrospective study, common echocardiographic markers were examined in infants>34weeks' gestation with PPHN (cases) and without PPHN (controls). Infants with congenital heart disease were excluded. Binary regression testing was used to evaluate echocardiographic markers predicting PPHN and death. In addition, diagnostic accuracy testing of echocardiographic markers using ROC was also performed. Intra-observer reliability for echocardiographic markers was examined using coefficient of variation (CoV) and intraclass correlation. Fifty-two infants were studied; 22 (42 %) infants with PPHN had significantly higher oxygen requirement, oxygenation index and ventilation days when compared with controls. Echocardiographic markers such as TR Vmax, S/D TR, PAAT, TAPSE and eccentricity index (EI) were significantly different between cases and controls. Receiver operator characteristics analysis of echocardiographic markers revealed TR Vmax 0.96 (0.9-1.0), S/D TR 0.95 (0.87-1.0) and end systolic EI 0.94 (0.87-1.0). These markers were found to predict death in this cohort of infants. CoV and Intra-observer reliability was good for various echocardiographic markers. Among the various echocardiographic markers studied, TR Vmax when present along with S/D TR and end systolic EI had good intra-observer reliability and were diagnostic of PPHN and predicted death in this cohort. Future trials could use these markers in studies examining PPHN.

Intra- and interobserver reliability of ocular surface analyzer LacryDiag®.

To invastigate intra- and interobserver reliability of interferometry, tear meniscus height (TMH) measurement and meibography (MBG) of an ocular surface analyzer, LacryDiag (Quantel Medical, France). Five consecutive measurements and subsequent analysis of interferometry, TMH, and MBG were recorded by two examiners using the LacryDiag. To assess intra- and interobserver reliability, we used Cohen's kappa for categorical variables (interferometry), or intraclass correlation coefficient for continuous variables (TMH, MBG). Thirty eyes of 30 examinees were included. For both observers, there was excellent intraobserver reliability for MBG (0.955 and 0.970 for observer 1 and 2, respectively). Intraobserver reliability for observer 1 was substantial for interferometry (0.799), and excellent for TMH (0.863). Reliability for observer 2 was moderate for interferometry (0.535) and fair to good for TMH (0.431). Interobserver reliability was poor for interferometry (0.074) and fair to good for TMH (0.680) and MBG (0.414). LacryDiag ocular surface analyzer in our study proves to be a reliable noninvasive tool for the evaluation of TMH and MBG. As for interferometry, poor interobserver reliability, fair to good intraobserver reliability for observer 1, and moderate for observer 2, leave room for improvement.

The Normal Active Range of Motion of the Index, Middle, Ring, and Little Fingers in a Sample of Indian Population.

Background The normative data for finger range of motion (ROM) are not available for the Indian population. The aim of our study was to measure the active ROM of finger joints in normal healthy volunteers in a sample of Indian population. Materials and Methods This is a prospective observational study conducted as a part of the Indian normative data project of the Indian Society for Surgery of the Hand (ISSH). The study included one participating center from four geographical regions of the country. Certified goniometers were used to measure the ROM of fingers in all centers. A standardized methodology was devised. A pilot study was done to assess the interobserver and intraobserver reliability, following which data were collected by one measurement. Results This pilot study was performed in 20 hands that showed good interobserver and intraobserver reliability correlation. A total of 390 hands were measured in four participating centers. Active flexion of metacarpophalangeal (MCP) joint was the highest in the middle finger (86.6 ± 10.4 degrees) followed by the index finger (86.0 ± 9.2 degrees), little finger (85.0 ± 8.4 degrees), and ring finger (84.2 ± 8.6 degrees). The index finger (97.2 ± 16.9 degrees) showed maximum proximal interphalangeal (PIP) joint flexion followed by the middle finger (96.2 ± 15.8 degrees), ring finger (96.0 ± 15.9 degrees), and little finger (91.8 ± 12.7 degrees). Distal interphalangeal (DIP) joint flexion increased from the index finger (81.6 ± 13.9 degrees) to the little finger (84.6 ± 12.9 degrees). The little finger MCP joint (26.3 ± 6.2 degrees) showed maximum extension followed by the index finger (25.7 ± 6.8 degrees), middle finger (24.7 ± 6.7 degrees) and ring finger (22.3 ± 7.1 degrees). The middle finger (15.6 ± 8.1 degrees) and ring finger (16.2 ± 8 degrees) had more PIP joint extension when compared to the index (13.7 ± 7.8 degrees) and little finger (13.2 ± 8.4 degrees). The ring finger (8.1 ± 6.8 degrees) and the middle finger (8.4 ± 6.9 degrees) had more DIP joint extension when compared with the index finger (6.0 ± 6.0 degrees) and the little finger (6.8 ± 6.7 degrees). Total active motion (TAM) of the middle finger (315.9 ± 31.0 degrees) was the maximum followed by the index finger (310.2 ± 27.3 degrees), ring finger (308.8 ± 29.1 degrees), and little finger (307.8 ± 25.2 degrees). Gender, body mass index (BMI), mother tongue, geographical location, and occupation were factors that had significant correlation, while no significant differences based on side, hand dominance, and age were noted. Conclusion We have reported normative data of finger ROM and TAM for the index, middle, ring, and little fingers in the Indian population. Finger ROM in the Indian population is highly variable. The observed TAM in the Indian population is higher than what is reported earlier.

The validity and reliability of CT scan based tibial plateau mapping for tibial plateau fractures

Introduction The Schatzker and computed tomography (CT)-based three-column classifications are the most used for tibial plateau fractures. The newer “10-segment classification” suggested to have better fracture identification and more accurate planning. This study aimed to assess the interobserver and intraobserver reliability of this new classification and to clarify its validity in clinical practice. Patients and methods A retrospective analysis of 30 patients with tibial plateau fractures who were admitted to a university hospital through the period between January 2020 and December 2022 was done. Patients with complete preoperative imaging, including radiographs, CT scans with three-dimensional reconstruction, and postoperative radiographs were included. Missing imaging, open fractures, pathological fractures, conservative management, or definitive fixation by circular external fixator were excluded. Data were reviewed independently by three expert trauma surgeons twice with 2-week intervals with randomization of case sequencing to evaluate their interobserver and intraobserver reliability for the Schatzker, CT-based three-column, and the new 10-segment classifications. The validity of the 10-segment classification was assessed by the agreement on the approach and implant position suggested by the observers. Results Good interobserver and intraobserver reliability was found as regards the Schatzker and CT-based three-column classifications on both intervals. Moderate and poor interobserver reliability “on both intervals respectively” and poor intraobserver reliability was found for the 10-segment classification. As regards the agreement on surgical approach on both time intervals, moderate and good interobserver agreements were found. For the implant position, poor interobserver agreement on both intervals was found. Intraobserver agreement for the surgical approach was good, while the intraobserver agreement for the implant position was moderate. Conclusion The Schatzker and CT-based three-column classifications are still more reliable than the newer 10-segment classification. This may be explained as it is still not familiar to surgeons and needs more training to be applied in clinical practice.

Effect of clinician's experience and expertise on the inter- and intra-observer reliability of the computed tomography-based classification systems in posterior malleolus fractures.

Three computed tomography (CT)-based classifications, including Haraguchi, Bartoníček-Rammelt, and Mason-Molloy systems, have been developed to better determine the characteristics of posterior malleolus fractures (PMFs). The aims of this study were (1) to determine the intra- and inter-observer reliability of the computed tomography-based classification systems and (2) to investigate the clinical experience and expertise on their reliabilities. Sixty-seven preoperative ankle CT scans of 67 adult patients with "ankle fracture with the involvement of the posterior malleolus"'' were retrospectively identified. CT images were assessed by 10 observers with different levels of clinical experience from 2 different specialties, including orthopedics and radiology. The observers were asked to classify PMFs according to 3 CT-based classifications on 2 separate occasions with a 4-week interval. Cohen's κ values were measured for 2 raters and Fleiss' κ values were measured for 3 raters and more. Overall, each classification had moderate to very good intraobserver reliability (κ=0.41 to 0.95, P < .01) as well as moderate interobserver reliability for each of the 2 separate assessments (κ=0.41 to 0.60, P < .01 for the first occasion; κ=0.44 to 0.59, P < .01 for the second occasion). Interobserver agreement among the foot and ankle surgeons regarding the Haraguchi and Bartoníček classifications was substantial for both assessment periods, whereas there was a moderate agreement for the Mason classification. Orthopedic residents showed moderate interobserver agreement in each period for both Bartoníček and Mason classifications. Radiology experts illustrated slight and fair agreements in the 2 assessments for Mason classification, moderate agreement in both assessments for Haraguchi classification, and substantial to moderate agreement in the first and second assessments for Bartoníček classification, respectively. Computed tomography-based classification system for PMFs demonstrated moderate interobserver reliability as well as moderate to very good intraobserver reliability. Moreover, foot and ankle specialists exhibit enhanced K values for both inter and intraobserver reliability for each classification system, consistency seems to increase as the interest in the field condenses.

Classification and measurement of displacement of isolated greater tuberosity fractures: Intra and interobserver reliability.

Literature demonstrates variability in the amount of displacement of isolated greater tuberosity (GT) fractures and measurement techniques that orthopaedic surgeons deem warrant surgical intervention. This study aims to assess the intra and interobserver reliability for classifying and measuring the displacement amount for isolated GT fractures. Eight surgeons, consisting of four shoulder specialists and four trainee surgeons, reviewed 25 plain radiographs on two separate occasions, 3 months apart. They were required to morphologically classify the GT fracture, measure the displacement distance on anteroposterior and axillary views, calculate the GT displacement ratio, and state whether they would offer surgical treatment. There was a lack of good reliability for the classification of the depression and avulsion fracture types. There was good intraobserver but poor interobserver consistency in classifying the split-type fractures. The measurement of the displacement distance showed good intraobserver reliability, but not as good interobserver agreement. Also, the displacement ratio calculated revealed poor consistency. We found good agreement between and within the raters for the treatment decision. No significant difference was noted when comparing the senior surgeons to the junior surgeons. This study has revealed ongoing inconsistency in the classification and measurement of isolated GT fractures.

SMART-ESAS: Smartphone Monitoring and Assessment in Real Time of Edmonton Symptom Assessment System Scores for Patients With Cancer.

Serial patient-reported outcome (PRO) measurements in clinical practice are associated with a better quality of life and survival. Recording electronic PROs using smartphones is an efficient way to implement this. We aimed to assess the feasibility of the electronically filled Edmonton Symptom Assessment System (e-ESAS) scale in the lower-middle-income country (LMIC) setting. Baseline clinical features and conventional paper-based ESAS (p-ESAS) were collected in newly diagnosed patients with solid organ tumors. Text message link was sent to these patients for filling e-ESAS. ESAS was categorized into physical, psychological, and total symptom domains. Scores were divided into none to mild (0-3) and moderate to severe (4-10). Intraclass correlation coefficients (ICCs) were used to determine the correlation between p-ESAS and e-ESAS. Multivariable logistic regression was used to identify independent factors affecting symptom burden. Of 1,160 participants who filled out p-ESAS, 595 completed both e-ESAS and p-ESAS questionnaires and were included in the final analysis. Moderate to severe physical, psychological, and total symptom scores were seen in 39.8%, 40%, and 39% of participants. Tiredness and anxiety were the most common physical and psychological symptoms, respectively. ICCs between the p-ESAS and e-ESAS varied between 0.75 and 0.9. Total symptom scores were independently predicted by metastatic disease (odds ratio [OR], 1.83; 95% CI, 1.26 to 2.67; P = .001) and a higher level of education (OR, 0.42; 95% CI, 0.25 to 0.72; P = .001). Paper-based and electronically filled ESASs have good intraobserver reliability across individual symptoms and domain scores in a representative cohort at a tertiary care institute in the LMIC. This may help us incorporate e-ESAS in routine clinical care in the real-world setting with financial, infrastructural, and manpower limitations.

Novel Modic grading scoring system and its clinical validation: a preliminary investigation.

To propose a novel Modic grading scoring system and explore the relationship between the Modic grading score and disc degeneration, disc herniation, disc height, and clinical symptom scores. In total, 194 patients were included in the study. The new Modic grading scoring system included four indicators: invaded vertebral height, invaded endplate length, endplate morphology, and grade of endplate defects. The severity of Modic changes was visually quantified by numerical scores, and the kappa value was used to verify the interobserver and intraobserver reliability. Spearman correlation analysis was used to explore the relationship between the Modic grading score and intervertebral disc degeneration, disc herniation, disc height, and clinical symptom scores. The interobserver and intraobserver reliability showed substantial to almost perfect agreement in the new Modic grading scoring system. The Modic grading score was positively correlated with intervertebral disc degeneration (r = 0.757, p < 0.001) and negatively correlated with the intervertebral disc height index (r = - 0.231, p < 0.001). There was no significant correlation between the Modic grading scoring system and disc herniation (r = 0.369, p = 0.249). Additionally, there was no significant correlation between the Modic grading score and the Japanese Orthopaedic Association score (r = - 0.349, p = 0.25), Oswestry Disability Index score (r = 0.246, p = 0.11), or visual analogue scale score (r = 0.315, p = 0.35). The new Modic grading scoring system had good interobserver and intraobserver reliability. The Modic grading score was positively correlated with intervertebral disc degeneration and negatively correlated with the intervertebral disc height.

THE RADIOGRAPHIC UNION SCORE FOR ULNAR FRACTURES (RUSU) PREDICTS ULNAR SHAFT NONUNION

To develop a reliable and effective radiological score to assess the healing of isolated ulnar shaft fractures (IUSF), the Radiographic Union Score for Ulna fractures (RUSU).Initially, 20 patients with radiographs six weeks following a non-operatively managed ulnar shaft fracture were selected and scored by three blinded observers. After intraclass correlation (ICC) analysis, a second group of 54 patients with radiographs six weeks after injury (18 who developed a nonunion and 36 who united) were scored by the same observers.In the initial study, interobserver and intraobserver ICC were 0.89 and 0.93, respectively. In the validation study the interobserver ICC was 0.85. The median score for patients who united was significantly higher than those who developed a nonunion (11 vs 7, p&lt;0.001). A ROC curve demonstrated that a RUSU ≤8 had a sensitivity of 88.9% and specificity of 86.1% in identifying patients at risk of nonunion. Patients with a RUSU ≤8 (n = 21) were more likely to develop a nonunion (n = 16/21) than those with a RUSU ≥9 (n = 2/33; OR 49.6, 95% CI 8.6–284.7). Based on a PPV of 76%, if all patients with a RUSU ≤8 underwent fixation at 6-weeks, the number of procedures needed to avoid one nonunion would be 1.3.The RUSU shows good interobserver and intraobserver reliability and is effective in identifying patients at risk of nonunion six weeks after fracture. This tool requires external validation but may enhance the management of patients with isolated ulnar shaft fractures.

Measurement of the Medial Clear Space: An Intra-Observer Comparison of Various Measurement Methods

Category: Ankle; Trauma Introduction/Purpose: The Medial Clear Space (MCS) is an anatomic space between the lateral cortex of the medial malleolus and the medial cortex of the talus. Measurement of the MCS is helpful in differentiating which ankle fractures are amenable to non- operative treatment, and which may require fixation. The MCS is often evaluated on radiographic views of the ankle, and several different methods of measuring the MCS have been described in the literature. There is little information on intra-observer reliability of MCS measurement, nor validation of the various medial clear space measurement techniques. As such, the aim of this study was to better understand intra-observer reliability of MCS via several of the most popularly described techniques. Methods: Patients with matched ankle X-rays and CT scans - either weight bearing or non-weight bearing imaging pairs - were identified via electronic medical record database review of a Level-1, academic medical system after IRB approval. Measurement of the MCS on CT scan was used as the gold standard against which radiographic measurements were compared given its superior osseous definition. Four independent reviewers measured the medial clear space on 20 weight bearing, and 20 non-weight bearing x-rays via the five most commonly described methods: 5mm inferior to the talar dome (MCS #1), half way down the medial articular surface of the talus (MCS #2), obliquely at the supero-medial corner of the talus (MCS #3), and at the level of the talar dome (MCS #4). Intraclass Correlation Coefficients (ICC) were then calculated for each of the four MCS measurements methods after compilation of all independent reviewer data. Results: The ICC varied between each of the four MCS measurement techniques. For measurements 5mm below the talar dome (MCS #1) the ICC was 0.041. Measured halfway down the medial talar articular surface, the ICC was 0.466. The superior oblique MCS measurement ICC was 0.725, and the MCS measured at the level of the talar dome had an ICC of 0.419. MCS measurement 5mm below the talar dome had poor intra-observer reliability, while measurement halfway down the medial articular surface and at the level of the talar dome had fair intra-observer correlation. Overall, measurement of the MCS at the superomedial talar dome had good intra-observer reliability, ranking as the most favorable measurement method. Conclusion: The commonality of ankle fractures demands accurate radiographic interpretation for the determination of need for surgical intervention. The medial clear space measurement is the most common metric used to determine the need for surgery. There is no consensus regarding the optimal method, nor reliability of the various MCS measurement techniques. The results of this study suggest that measurement of the medial clear space at the superomedial corner of the talar dome has the highest intra- observer reliability.

RETINAL VASCULITIS SEVERITY ASSESSMENT: Intraobserver and Interobserver Reliability of a New Scheme for Grading Wide-Field Fluorescein Angiograms in Retinal Vasculitis.

Wide-field fluorescein angiography is commonly used to assess retinal vasculitis (RV), which manifests as vascular leakage and occlusion. Currently, there is no standard grading scheme for RV severity. The authors propose a novel RV grading scheme and assess its reliability and reproducibility. A grading scheme was developed to assess both leakage and occlusion in RV. Wide-field fluorescein angiography images from 50 patients with RV were graded by four graders, and one grader graded them twice. An intraclass correlation coefficient (ICC) was used to determine intraobserver-interobserver reliability. Generalized linear models were calculated to associate the scoring with visual acuity. Repeated grading by the same grader showed good intraobserver reliability for both leakage (ICC = 0.85, 95% CI 0.78-0.89) and occlusion (ICC = 0.82, 95% CI 0.75-0.88) scores. Interobserver reliability among four independent graders showed good agreement for both leakage (ICC = 0.66, 95% CI 0.49-0.77) and occlusion (ICC = 0.75, 95% CI 0.68-0.81) scores. An increasing leakage score was significantly associated with worse concurrent visual acuity (generalized linear models, β = 0.090, P < 0.01) and at 1-year follow-up (generalized linear models, β = 0.063, P < 0.01). The proposed grading scheme for RV has good to excellent intraobserver and interobserver reliability across a range of graders. The leakage score related to present and future visual acuity.

The Radiographic Union Score for ulnar fractures (RUSU) predicts ulnar shaft nonunion.

To develop a reliable and effective radiological score to assess the healing of isolated ulnar shaft fractures (IUSF), the Radiographic Union Score for Ulna fractures (RUSU). Initially, 20 patients with radiographs six weeks following a non-operatively managed ulnar shaft fracture were selected and scored by three blinded observers. After intraclass correlation (ICC) analysis, a second group of 54 patients with radiographs six weeks after injury (18 who developed a nonunion and 36 who united) were scored by the same observers. In the initial study, interobserver and intraobserver ICC were 0.89 and 0.93, respectively. In the validation study, the interobserver ICC was 0.85. The median score for patients who united was significantly higher than those who developed a nonunion (11 vs. 7, p < 0.001). A ROC curve demonstrated that a RUSU ≤ 8 had a sensitivity of 88.9% and specificity of 86.1% in identifying patients at risk of nonunion. Patients with a RUSU ≤ 8 (n = 21) were more likely to develop a nonunion (n = 16/21) than those with a RUSU ≥ 9 (n = 2/33; OR 49.6, 95% CI 8.6-284.7). Based on a PPV of 76%, if all patients with a RUSU ≤ 8 underwent fixation at 6 weeks, the number of procedures needed to avoid one nonunion would be 1.3. The RUSU shows good interobserver and intraobserver reliability and is effective in identifying patients at risk of nonunion six weeks after fracture. This tool requires external validation but may enhance the management of patients with isolated ulnar shaft fractures.

Evaluation of the medically necessary, time sensitive triage score during and beyond the local COVID-19 pandemic in the Gynaecologic Oncology Unit of a tertiary hospital in South Africa.

The main objective of this study was to evaluate the Medically Necessary Time Sensitive (MeNTS) scoring system in triaging gynaecologic oncologic surgery during and beyond the COVID-19 pandemic. This was a retrospective cross-sectional study including 209 patients who either had surgery (151) or surgery postponed (58) between the 26th March and 30th September 2020 in an academic hospital in South Africa. The MeNTS score was used to independently score each patient three times by two observers. The mean age of the participants was 46.6 ± 15 years and the cumulative mean MeNTS score was 51.0 ± 5.1. Over two-thirds of the cases had surgery. There was no significant difference between the first and second observers' cumulative scores, 51.0 vs 51.1 (p 0.77). The cumulative score among those who had surgery was significantly lower than that for those whose surgeries were postponed, 49.8 vs 54.1 (p <0.0001). The intra-observer and inter-observer reliability were 0.78 and 0.74 respectively. After adjusting for confounding variables, those with low cumulative MeNTS scores were about 5 times more likely to have surgery than those with high scores (Adj. OR = 4.67, 95% CI: 1.92-11.4, p <0.001. Patients with malignant diagnosis were also 5 times more likely to be operated than those with benign diagnosis (Adj. OR = 5.03, 95% CI: 1.73-14.6, p <0.001. The area under the curve (AUC) was 0.85 suggesting an excellent discriminatory power between those who were operated and those who were postponed. The study provided some insight into the potential usefulness of MeNTS score in prioritizing patients for surgery in gynaecologic oncologic sub-specialty. The score performed well across a range of gynaecologic conditions and procedures with good intra-observer and inter-observer consistency and reliability. This is a prioritization tool that is dynamically adaptable to accommodate changes in resources availability and operating theatre capacity.

SARCOPENIA AS A PREDICTOR OF MORTALITY IN PATIENTS WITH METASTATIC TUMOURS IN THE SPINAL COLUMN

Sarcopenia has been observed to be a predictor of mortality in international studies of patients with metastatic disease of the spine. This study aimed to validate sarcopenia as a prognostic tool in a New Zealand setting. A secondary aim of this study was to assess the intra-observer reliability of measurements of psoas and vertebral body cross sectional areas on computed tomography imaging.A cohort of patients who had presented to Waikato Hospital with secondary neoplasia in the spinal column from 2014 to 2018 was selected. Cross sectional psoas and vertebral body areas were measured at the mid-pedicle L3 level, followed by calculation of the psoas to vertebral body cross sectional area ratio. Psoas to vertebral body cross sectional area ratio was compared with survivorship. The strength of the correlation between sarcopenia and survivorship was compared with the correlation between serum albumin and survivorship, as well as the correlation between the Metastatic Spine Risk Index (MSRI) and survivorship.A total of 110 patients who received operative (34) and non-operative (76) were included. The results demonstrate that psoas to vertebral body cross sectional area ratio is not statistically significantly correlated with survivorship (p=0.53). Serum albumin is significantly correlated with survivorship (p&lt;0.0001), as was the MSRI. There is good intra-observer and inter-observer reliability for measurements of psoas to vertebral body cross sectional area.This study failed to demonstrate the utility for the psoas to vertebral body cross sectional area ratio that other studies have demonstrated in estimating survivorship. Serum albumin levels remain a useful prognostic indicator in patients with secondary tumours in the vertebral column.

Variability, Validity and Operator Reliability of Three Ultrasound Systems for Measuring Tissue Stiffness: A Phantom Study

Introduction Ultrasound elastography is a method of measuring soft tissue stiffness to detect the presence of pathology. There are several ultrasound elastography devices on the market. The aim of this study was twofold. Firstly, to determine the validity of three different ultrasound systems used to measure tissue stiffness. Secondly, to determine the operator reliability and repeatability when using these three systems. Materials and methods Two observers undertook multiple stiffness measurements from a phantom model using three different ultrasound systems; the LOGIQ E9, the Aixplorer, and the Acuson S2000. The phantom model had four cylindrical-shaped inclusions (Type 1-4) of increasing stiffness values and diameter embedded within. The background phantom stiffness was fixed. The mean, standard deviation, and coefficient of variation (CV) were calculated from measured stiffness readings per diameter per inclusion. Intra-observer variability was assessed. The validity of the measured stiffness value was assessed by calculating the difference between the measured elasticities and actual phantom elasticities. Bland-Altman plots with limits of agreement were used to display the inter-observer agreement. The intraclass correlation coefficients (ICC) were used to measure intra-observer, inter-observer, and inter-system reliability. Results Each observer undertook 1020 measurements. All three systems generally underestimated the stiffness values for the inclusions; the higher the actual stiffness value, the more significant the underestimation. The percentage difference between measured stiffness and actual stiffness varied from -79.1% to 12.7%. The intra-observer variability was generally less than 5% for observers using the LOGIQ E9 and the Aixplorer systems but more than 10% over the stiffer inclusions (Types 3 and 4) for the Acuson system. There was 'almost perfect' intra-observer reliability and repeatability for both the LOGIQ E9 and the Aixplorer systems; this was 'moderate' for the Acuson system over specific inclusions. For all systems, there was 'almost perfect' inter-observer reliability and repeatability between Observer A and Observer B. The inter-system reliability and repeatability were 'almost perfect' between the LOGIQ E9 system and the Aixplorer system but 'poor' and 'moderate' when the Acuson system was matched with the LOGIQ E9 system and the Aixplorer system, respectively. Conclusion This study has demonstrated that the Acuson, LOGIQ E9, and Aixplorer ultrasound systems have low variability, high reproducibility, and good intra-observer and inter-observer reliability when used to measure tissue stiffness. However, they all underestimated the stiffness values during this in vitro study. This study also revealed that not all ultrasound systems are comparable when measuring tissue stiffness, with some having better inter-system reliability than others. Ongoing standardization of technology is required at the manufacturer level.

Optimal K-Wire Placement for Indirect Cannulated Screw Fixation of Coronoid Process Fractures: A Radiology-Based Guide

Indirect fixation of coronoid process fractures of the ulna, especially arthroscopically, offers the possibility to avoid extensive medial surgical approaches. However, optimal placement of K-wires for cannulated screw fixation is technically challenging. The aim of the present study was to present guide values for K-wire placement for indirect screw fixation of coronoid tip (COT) and anteromedial facet (AMF) fractures of the ulna. Computed tomography scans of the elbows of 197 patients with an uninjured ulna were identified and evaluated following a standard measuring protocol. Optimal placement of K-wires was defined as the bisector between the anterior and articular cortex while respecting a 1.6-mm safe zone for each placement. This placement of the K-wires in the COT and the AMF was analyzed by measuring the wire angulation in relation to the posterior ulnar cortex (AUC), the distance from the entry point to the posterior olecranon edge (DPE), and the intraosseous length (IOL). Because the coronoid has a curved shape, measurements of the COT and AMF were expected to differ significantly. Sex was also expected to influence measurements. To determine whether this optimal placement of K-wires can be reliably identified, interobserver and intraobserver reliabilities were evaluated. To address tip fragments, we determined a mean AUC of 64°, DPE of 36 mm, and IOL of 38 mm. Regarding wire placement toward the AMF, the means for the AUC, DPE, and IOL were 79°, 27 mm, and 33 mm, respectively. Statistically significant differences were found between the COT and the AMF for the AUC, DPE, and IOL. Our measuring protocol showed good interobserver and intraobserver reliability. K-wire placement toward the COT demands a smaller angle, a longer IOL, and a more distal entry point than wires placed toward AMF. These differences reflect the curved and complex anatomy of the coronoid. This measuring algorithm can be used to plan osteosynthesis, and the obtained reference values can help understand the coronoid's complex anatomy.

Patella-Posterior Turning Point of the Distal Femur Distance Is a Potential Indicator for Diagnosing Patella Alta in Recurrent Patellar Dislocation Population

To introduce a simple patellar height measurement method (patella-posterior turning point of the distal femur [P-PTP] Distance) independent of patellar anatomy with standardized patient position, and tested the reliability, validity, and diagnostic accuracy compared with commonly used ratios in knee extension. We retrospectively reviewed 418 computed tomography (CT) images of the knee joint in a group of patients who were diagnosed recurrent patellar dislocation (RPD). With the three-dimensional (3D) CT reconstructed knee, patellar height was qualitatively assessed by the patellar engagement with the femoral trochlea in terminal knee extension to divide RPD population into case (patella alta) and control group. With digitally reconstructed lateral radiographs, patellar height was measured with P-PTP distance (perpendicular distances between the distal edge of patella articular surface and posterior turning point of distal femur), and four commonly used ratios: Caton-Deschamps index, Modified Insall-Salvati index, Blackburne-Peel index, and Insall-Salvati index. An unpaired t-test was conducted to determine significant differences between groups. Correlation coefficient, intra- and inter-observer reliability, receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC) were also calculated. 198 knee images (198 patients) were included for final evaluation. Patella alta was present in 72 knees (36.3%) with RPD. The effect size was relatively large between the case and control group for P-PTP distance (d=-1.619; 95% CI,-1.948 to-1.286). P-PTP distance correlated moderately to strongly with four commonly used ratios (P < .001). Intraobserver and interobserver reliability was good for P-PTP distance. The AUC of the ROC curve was categorized as excellent for P-PTP distance, better than other measurements (P < .001), and the cutoff value was 4.2 mm with the highest sensitivity (86.11%) and specificity (84.92%). The measurement method, P-PTP distance, showed good intra-observer and inter-observer reliability, well correlated with commonly used ratios, and presented best diagnostic accuracy among commonly used ratios for predicting RPD. P-PTP distance might be a potential indicator for identifying patella alta in RPD patients when supine and knee extended. The measurement reported in this study may help in advancing clinical evaluation of patella alta, providing an alternative and simple method to measure patellar height. Standing or weight-bearing plain lateral radiographs obtained from the routine practice should be further assessed in the next step to further validate the method.

The Sanders Maturity Scale for skeletal maturity assessment in idiopathic scoliosis

Introduction. Skeletal maturity assessment in Idiopathic Scoliosis (IS) is used for the evaluation of deformation progression risk, as well as selecting a method of treatment. The Sanders Maturity Scale (SMS) is based on the ossification of phalanges, metacarpal bones and radius rated on AP radiograms of the left hand. Aim. This retrospective study aimed to compare SMS to other skeletal maturity assessment methods used in daily practice. Materials and methods. We included 39 female patients with IS (50 series of radiograms) with a mean age of 13.4, ranging from 10.3 to 17.3. Each series of radiograms was evaluated by three observers with different experience. Skeletal maturity was assessed using the Sanders Maturity Scale (SMS), Risser sign, Greulich and Pyle (GP) atlas, as well as the closure of the triradiate cartilage. Results. The majority of patients, 17 out of 50 (34 %) were classified as type 3 (adolescent rapid – early). Intra-observer and inter-observer reliability for the SMS was very good (Krippendorff’s alpha &gt;0.95). The GP and Risser method showed good reliability, whereas the triradiate cartilage closure assessment showed lower reliability. The Risser 0 grade corresponded with as many as four Sanders stages, 16 out of 20 (80 %) were rated Sanders 3. All radiograms with open triradiate cartilage (7/50, 14 %) were rated Sanders 2 or 3; they all received a Risser 0 grading. Conclusions. The SMS proved to have a very good intra-observer and inter-observer reliability, it is easy to be used by physicians and does not require an atlas. The SMS enhances the assessment of skeletal maturity of IS patients by providing additional stages in the early phase of growth (Risser 0).