Intraobserver Reliability Research Articles

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

Osteoporotic 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. A 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-5L, adjacent fracture incidence, local kyphotic angle, and reoperation rates. Patients with at least 1-year follow-up were included. A 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. The 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.

Morphology of the human inner ear and vestibulocochlear nerve assessed using 7T MRI.

To optimize high-resolution 7T MRI of the cochlea and measure normal cochlea and the cochlear nerve morphometry in vivo. Eight volunteers with normal hearing were scanned at 7T using an optimized protocol. Two neuroradiologists independently scored image quality. The basal turn lumen diameter (BTLD), height, width, length and volume of the cochlear, long (LD) and short (SD) diameter the calculated cross-sectional area (CSA) of the cochlear nerve were measured. Intra and inter-observer reliability was assessed using intraclass correlation (ICC). 3D T2W DRIVE combined with dielectric pads, allowed acquisition of high-resolution images showing detailed structures, such as the crista ampullaris in the semicircular canals. The overall grading scores from neuroradiologists were excellent. In the left ear, averaging over all subjects gave BTLD of 2.6 ± 0.05mm, height of 4.9 ± 0.1mm, width of 4.4 ± 0.2mm, length of 36.5 ± 0.4mm, volume of 0.16 ± 0.02ml, LD of 1.31 ± 0.1mm, SD of 1.06 ± 0.1mm, and CSA of 1.1 ± 0.1 mm2. The right ear gave BTLD of 2.6 ± 0.04mm, height of 4.9 ± 0.1mm, width of 4.4 ± 0.3mm, length of 35.5 ± 0.4mm, volume of 0.16 ± 0.02ml, LD of 1.29 ± 0.1mm, SD of 1.07 ± 0.1mm, and CSA of 1.10 ± 0.2 mm2. No statistically significant difference was found between the sides of the head (p-value > 0.05). The intra-observer reliability was high (0.77-0.94), while the inter-observer reliability varied from moderate to high (0.55-0.81). 7T MRI can provide excellent visualization of the internal structure of the cochlear and of the vestibulocochlear nerve in vivo.

Nomograms of fetal thoracic dimensions from 17 to 37 weeks of gestation

Abstract Introduction: We aimed to construct the nomograms for fetal thoracic parameters among Thai fetuses that were between 17 and 37 gestational weeks, as assessed by three distinct two‐dimensional (2D) measurement techniques (thoracic diameter, circumference and area) and compare our findings with those of previous publications. Methods: A cross-sectional study involving 511 low-risk singleton pregnancies with normal fetuses at Siriraj Hospital, Bangkok, Thailand, was conducted. Using the four-chamber view, fetal thoracic measurements were obtained through three 2D sonographic measurement methods. Reference intervals at 95% and Z-scores were established for all techniques based on gestational age (GA) and biparietal diameter (BPD). Intraclass correlation coefficients (ICCs) were computed to assess reproducibility of the measurement methods. Results: Measurements of fetal thorax size exhibited consistent, proportional increases with advancing GA and BPD across all techniques. Intraobserver and interobserver reliability coefficients for all methods indicated excellent agreement, with all ICCs being at least 0.991. Nomograms of fetal thoracic diameter, circumference and area across GA and BPD were constructed from the obtained values. Discrepancies in Z-score reference ranges for fetal thoracic circumference were noted between the present study and previous research in other populations, particularly among Caucasians. Conclusion: Our study established normal reference ranges for evaluating fetal chest size through three different methods from 17 to 37 weeks of gestation in the Thai population. Nomograms may vary due to population differences, emphasising the importance of using reference values from similar demographic groups. The findings could potentially be used to identify fetuses that are at risk of abnormal thoracic dimensions or thoracic dysplasia.

Reliability of interobserver and intraobserver assessments of the Tile versus Young-Burgess classifications for pelvic ring injuries

Tile and Young-Burgess classification systems have been widely used to classify pelvic ring injuries in clinical settings; however, these two systems are rarely mentioned in the literature despite their reproducibility and practical application. The purpose of this study was to assess the interobserver and intraobserver reliability of the Tile and Young-Burgess classification of pelvic ring injuries. Eight hundred seven patients with pelvic fractures who presented to two I-level trauma centres between January 2016 and June 2020 were recruited for this study. The anteroposterior, inlet, and outlet of the pelvis were observed on radiographic images, and CT scans were performed on each patient. The anteroposterior, inlet, and outlet of the pelvis were radiographed at each visit, and CT scans were performed. Four observers were recruited to classify the injury type according to the Young-Burgess and Tile classification systems. Interobserver and intraobserver reliability (kappa coefficient, κ) were applied to assess the reproducibility of the two classification systems. A total of 174 patients (21.56%) could not be classified with the Young-Burgess classification, and all patients could be classified according to the Tile system. The mean κ value of the interobserver reliability was 0.558 (range, 0.444 to 0.653) for the Tile classification, indicating moderate agreement, whereas the mean κ value was 0.637 (range, 0.560 to 0.713), indicating substantial agreement, when the Young-Burgess classification was used. The mean κ value for intraobserver reliability was 0.597 (range, 0.567 to 0.653) for the Tile classification and 0.776 (range, 0.748 to 0.803) for the Young-Burgess classification. More pelvic ring injuries could be classified with the Tile classification than could be classified with the Young-Burgess classification. However, the reproducibility of the Young-Burgess classification was greater than that of the Tile classification.

Late olfactory bulb involvement in COVID19.

Transient or persistent hypo-anosmia is common in SARS‑CoV‑2 infection but olfactory pathway late-term morphometric changes are still under investigation. We evaluated late olfactory bulb (OB) imaging changes and their correlates with the olfactory function in otherwise neurologically asymptomatic COVID-19 patients. Eighty-three subjects (mean-age 43±14 years; 54 females; time-interval infection/MRI: 129±68 days) affected by asymptomatic to mild COVID19 in 2020 and 25 healthy controls (mean-age 40±13 years; 9 females) underwent 3T-MRI and olfactory function evaluation through anamnestic questionnaire and Sniffin' Sticks. Exclusion criteria were intensive care treatment or neurological involvement other than olfaction. Maximal OB area was measured blindly on high-resolution coronal T2w images by two observers. Patients were subdivided into: i) persistently hypo/anosmic, ii) recovered normosmic and iii) never complaining smell dysfunction with proven normal olfactory function. No significant differences were observed among patients' subgroups (p=0.76). Intra-observer and inter-observer reliability were high.(r=0.96 and 0.86). Former COVID19 patients had decreased mean maximal OB area than controls (6.52±1.11mm2 vs 7.26±1.17mm2, p=0.008) even when considering persistently hypo-anosmic (6.46±0.90, p=0.006) or normosmic patients at MRI (6.57±1.25, p=0.04). SARS-CoV-2 infection is associated with mid/late-term morphological changes on the olfactory bulbs, regardless of presence or persistence of olfactory dysfunction. The long-term consequences on olfactory aging need to be further investigated including possible links with neurodegenerative disorders.

Reliability of distal radius fracture classification systems: a CT based study.

To assess the reliability and reproducibility of AO/OTA, Frykman and Fernandez classification systems for distal radius fractures on CT. Four radiologists, including one radiology resident, two musculoskeletal radiology fellows and one radiology consultant independently evaluated CT scans of 115 patients with distal radius fractures and classified the fractures according to AO/OTA, Frykman and Fernandez classification system. To assess reproducibility, a second set of reading was done by two observers after an interval of six weeks. Interobserver reliability was calculated for each classification system using intraclass correlation coefficient (ICC) and using Light's modification of kappa. Intraobserver agreement was calculated using Cohen's kappa. Interobserver reliability using ICC showed fair agreement for AO/OTA (0.447) and Frykman (0.432) classification system and poor agreement for Fernandez (0.196) classification system. Interobserver agreement using kappa was moderate for AO/OTA fracture (0.447) classification into either of three types, while it was only slight for complete classification into type, group and subgroup (0.177). Interobserver agreement using kappa was slight for Fernandez (0.196) classification systems and moderate for Frykman classification system (0.406). Intraobserver agreement for AO/OTA classification system was moderate for observer 1 (0.449) and slight for observer 2 (0.162). Intraobserver agreement for Frykman classification system was substantial for observer 1(0.754) and moderate for observer 2 (0.496). Intraobserver agreement for Fernandez classification system was moderate for both the observers (0.333, 0.320). Currently there is no classification system that is fully reproducible. AO/OTA and Frykman classification systems performed better than Fernandez classification system in terms of interobserver reliability. However, Frykman classification system performed better than both AO/OTA and Fernandez classification system in terms of intraobserver reproducibility. Fernandez classification system had worst inter and intraobserver reliability in present study. Reliability and reproducibility of AO/OTA classification system decreased when fractures were divided into subgroups.

Accuracy and reliability of imaging modalities for studying bipolar bone loss in anterior shoulder instability: A systematic review.

Recurrent shoulder instability, a common musculoskeletal disorder, often involves glenoid bone loss and Hill-Sachs lesions. However, the optimal imaging modality for accurately and reliably quantifying bipolar bone loss remains uncertain. This systematic review aims to evaluate the accuracy and reliability of various imaging modalities in assessing bipolar bone loss in anterior shoulder instability. Major electronic databases were searched for English-language studies reporting the measurement of glenoid track width and/or determination of on/off track HSL through imaging. Studies reporting statistical measures such as area under the curve, sensitivity, specificity, positive predictive value, NPV, intraobserver reliability and interobserver reliability were included. Data extraction and risk of bias assessment were performed independently by two reviewers. The systematic review included 19 studies comprising 1567 shoulders. Overall, studies could be divided into those looking at the accuracy or reliability of determining glenoid track width, on- or off-track Hill-Sachs lesions and near-track lesions. Three-dimensional images of computed tomography (3D-CT) was the most reliable and accurate imaging modality to measure the glenoid track width. On the opposite, two-dimensional magnetic resonance imaging (2D-MRI) did not provide enough evidence of accuracy and reliability in the determination of On/Off track lesions and near-track lesions. 3D-CT demonstrated excellent reliability for measuring glenoid track width. However, the reliability of 2D-MRI for determining on/off track Hill-Sachs lesions is still controversial. Level III.

Enhancing preoperative diagnosis of pancreatic ductal adenocarcinoma and mass-forming chronic pancreatitis: a study on normalized conventional MR imaging parameters.

To assess the utility of signal intensity ratio (SIR) in distinguishing between mass-forming chronic pancreatitis (MFCP) and pancreatic ductal adenocarcinoma (PDAC), thereby reducing unnecessary pancreatectomies or delayed diagnosis brought by misdiagnosis. This retrospective study included 170 participants (34 with MFCP and 136 with PDAC) who underwent radical pancreatic surgery and were diagnosed via specimen pathology. The study group was carefully selected with a 1:4 ratio matching for sex, age, and operation time between two entities. T1 SIR, T2 SIR, arterial phase (AP) SIR, portal venous phase (VP) SIR, delay phase (DP) SIR, DWI0-50 SIR, and DWI500-1000 SIR, were calculated by dividing the signal intensity of lesions by that of the paraspinal muscle, serving as a reference organ. Intraclass Correlation Coefficient (ICC) was estimated to evaluate the intraobserver and interobserver reliability. Wilcoxon tests were employed for univariate analysis, and receiver operating characteristic (ROC) curves were generated to determine optimal cutoff points and AUC values for selected predictors. A tenfold cross-validation method was applied to validate the robustness of the results. The ICC demonstrated excellent correlation for both intraobserver and interobserver(ICCs > 0.8). T1 SIR, AP SIR, VP SIR, and DP SIR were significantly lower in the PDAC group compared to the MFCP group, and exhibited good independent predictive properties with the sensitivities of 61.8, 61.8, 70.6, and 73.5%, specificities of 66.2, 68.4, 59.6, and 55.9%, and AUCs of 0.620, 0.659, 0.670, and 0.668, respectively, hovering around 0.7. The tenfold cross-validation confirmed the reliability and robustness of our findings, with consistent AUC, sensitivity, specificity, and 95% confidence intervals over 1000 iterations. T1 SIR, AP SIR, VP SIR, and DP SIR show promise as potential imaging biomarkers for distinguishing between MFCP and PDAC.

Erect weight-bearing pelvic radiographs are superior to supine radiographs for diagnosis of mixed type acetabular retroversion plus developmental dysplasia hip deformity

PurposeThis study focused on the mixed-type deformities of acetabular retroversion (AR) and developmental dysplasia hip deformity (DDH) and aimed to ascertain the changes in pelvic tilt from a supine to a standing position in these cases and identify potential underlying mechanisms. MethodsA retrospective study was conducted on cases with symptomatic DDH from January 1, 2019, to April 30, 2023. DDH was defined as LCEA < 20°. AR was diagnosed by using a crossover index threshold of 0.2 in standing pelvic X-ray. Two observers assessed the supine and weight-bearing pelvic radiographs, along with computed tomography (CT) scans. The evaluated parameters included pelvic tilt (sacrofemoral-pubic angle (SFP), symphysis to sacrococcygeal distance (PSSC), pubic symphysis to sacroiliac (PSSI)), acetabular retroversion (crossover index, posterior wall sign), acetabular coverage (lateral center-edge angle (LCEA), ischial spine sign (ISS)), and axial rotation of the hemipelvis (pelvic width index, obturator index, and ilio-ischial angle). Acetabular orientation and coverage was measured by CT through anterior sector angle (ASA), posterior sector angle (PSA) and acetabular anteversion (AA). Cases with acetabular retroversion plus DDH were defined as the mixed-type deformity. Comparative analyses between mixed-type deformities and DDH cases were performed along with subgroup and correlation analyses within mixed-type cases. Inter-observer and intra-observer reliabilities were assessed using intraclass correlation coefficients. ResultsA total of 85 were included. 26 cases (30.59%) had mixed-type deformity, where transition from the supine to standing position led to an increased posterior pelvic tilt (SFP (supine: 64.35±4.6°, standing: 74.75±4.16°, p<0.001), PSSC (supine: 6.37±2.47, standing: 2.08±1.32, p<0.001) and PSSI (supine: 9.47±1.66, standing: 6.33±1.08, p<0.001)). Compared to cases with DDH, CT examination revealed a significantly greater anterior acetabular coverage and less posterior superior coverage, with smaller posterior sector angle and greater anterior sector angle (ASA) (p<0.05) for cases with AR. The superior iliac wing angle (mixed type: 45.63±9.22°, isolated type: 50.70±8.77°, p=0.013), inferior iliac wing angle(mixed type: 60.77±8.24°, isolated type: 65.24±8.02°, p=0.013), and ischiopubic angle (IPA) (mixed type: 32.27±3.19°, isolated type: 36.71±5.38°, p<0.001) were significantly reduced in AR cases, suggesting external rotation of the hemipelvis. Subgroup analysis showed that cases with a higher crossover index had a significantly higher PSSC and a significantly lower IPA. ConclusionAR was observed in 31% of DDH cases and was associated with a notable posterior pelvic tilt during postural transitions. This tilt appeared to be a compensatory mechanism affecting the AR diagnosis. Key changes in the acetabular coverage, including increased anterior coverage and decreased superior posterior coverage, were also observed. Additionally, external rotation of the hemipelvis in mixed-type cases correlated strongly with the extent of AR and anterior acetabular coverage, suggesting that it may be a key contributor to the underlying mechanism of this mixed-type deformity. Level of evidenceIII, retrospective case series.

Determination of Maxillary and Mandibular Arch Width in Angle’s Class I Patients

Introduction: The transverse dimension plays a key role in smile. Maintaining the pretreatment arch form is a key to obtaining stable results. Objectives: The main aim of this study was to determine mean intercanine arch width and mean intermolar arch width in Angle’s class I patients. Methods: Seventy-six pretreatment casts were obtained from the records of patients who sought orthodontic treatment in Orthodontics and Dentofacial Orthopedics. Four parameters were used in this study namely; intercanine arch width and intermolar arch width in maxilla and mandible. Linear measurements were carried out with digital caliper. Kappa test was done for intra-observer reliability. Shapiro-Wilk test was done to determine the normal distribution of data. The Pearson Correlation test was done to assess the correlation between intercanine and intermolar arch width in maxilla and mandible. The independent t-test was used to compare between intercanine and intermolar arch width with male and female. Results: Mean intercanine arch width in maxilla and mandible were 35.41±1.47 mm and 26.85±1.59 mm respectively. Mean intermolar arch width in maxilla and mandible were 53.82±2.82 mm and 51.71±2.60 mm respectively. Statistically significant difference was found between intercanine and intermolar arch width in maxilla and mandible between male and female. The intercanine and intermolar arch width in maxilla and mandible has significantly low correlation. Conclusions: Intercanine and intermolar arch width in male and female were statistically significant and male has lager intercanine and intermolar arch width than female.

Cone-beam CT volumetry: a new method for evaluating osteotomy healing - a clinical evaluation and MDCT comparison.

Fracture healing complications remain a major problem in trauma monitoring. An open wedge osteotomy of the distal radius provides a unique way of evaluating fracture healing. Since the introduction of cone-beam computed tomography (CBCT) at our institution, it has become the method of choice for assessing hand and wrist bones. To date, CT volumetry has been validated for multidetector CT (MDCT) but not for CBCT. To assess osteotomy healing using CBCT volumetry and to evaluate two different segmentation techniques. A total of 36 patients were surgically treated for malunited distal radius fractures with open-wedge osteotomy either leaving the void empty (open wedge empty [OWE]) or filled with bone graft substitutes (BGS). They were scanned using CBCT and MDCT postoperatively and after 3, 6, and 12 months. Segmentation was performed both manually and semi-automatically for volumetric measurement. Inter- and intra-observer reliability were assessed using intraclass correlation (ICC). The median osteotomy volume in the OWE group postoperatively was 0.87 cm3 (range=0.42-2.72). At 3 months, all but one of the OWE volumes had diminished to half or less of their initial volume. In the BGS group, the median postoperative volume was 1.30 cm3 (range=0.73-1.81) and at 12 months, 76% of the initial volume remained. Reliability between CBCT and MDCT volumetry expressed as ICC was ≥0.96. ICC for the two segmentation techniques was ≥0.99 and ICC for inter-observer reliability ≥0.97. CBCT volumetry is a reliable tool and comparable to MDCT to quantify bone healing of an osteotomy.

Scale for the assessment of mucosal wave dynamics of the free edges during stroboscopic examination: clinical validation study and analysis of results.

Identifying the mucosal wave (MW) is essential when studying the voice; however, its characterization and perceived measurement during laryngeal stroboscopy (LS) are not well defined or standardized because of the subjectivity of its interpretation. This article proposed and validated a scale that characterized and approximated MW measurement during LS, applied it to participants divided into a healthy group and groups with free edge conditions, and identified differences between them. This is a descriptive and clinical validation study of the "VASQ (Vertical axis, Anteroposterior axis, Symmetry and Quantity) mucosal wave score" scale based on stroboscopy images of 137 adult men and women divided into a control group and functional and organic pathology groups. The images were analyzed by three evaluators according to an established protocol. Measurements dictating the reproducibility and validity criteria as well as the MW score in each group were obtained. The reliability of the scale was α = 0.90, internal consistency success rate was 91%, intra-observer reliability was 0.83, inter-observer reliability was 0.83, content validity coefficient was 0.92, and factor loading was 0.37-0.53. The MW total score values between 5 and 6 were established as a reference for normality (P < 0.05). Organic pathology showed lower MW score values (P < 0.05), and functional pathology to a lesser extent (P > 0.05). The proposed scale is a consistent, valid, and reliable tool. Its widespread application would favor commonly used terminology and facilitate quantitative comparisons in future studies.

Radiographic features and subtypes of congenital thumb duplication type C3 according to Wu et al. and their potential implications for surgical management: new classification and preliminary results

BackgroundWu et al. introduced a modified radiographic system that allows classification of all forms of CTD with excellent interobserver and intraobserver reliability. No study to date has evaluated the radiographic characteristics of Wu et al. type C3 CTD with osseous attachment at the level of the metacarpal.ObjectiveThis study aimed to evaluate the radiographic features of type C3 CTD according to the system of Wu et al., to describe the different anatomical subtypes of the duplication, and to propose a categorization approach to distinguish diverse surgical strategies based on the radiographic anatomy of this specific subtype of duplication.MethodsWe performed a retrospective analysis of 215 patients (221 thumbs) diagnosed with Wu et al. type C3 CTD at our Institution between 2015 and 2021. We evaluated all CTDs by examining the alignment of the interphalangeal (IP) and metacarpophalangeal (MP) joints and by assessing the presence of abnormal hypertrophic epiphysis of the primary thumb on posteroanterior (PA) radiographs. The proposed classification system has four types: Type I with good alignment of both MP and IP joints, Type II with ulnar deviation of the MP joint, Type III with radial deviation in the MP joint and Type IV with abnormal hypertrophic epiphysis of the distal phalanx of the main thumb with ulnar deviation of the IP joint with or without ulnar deviation of the MP joint.ResultsThere were 140 male and 75 female patients with CTD (221 thumbs). There were 65 left, 144 right and 6 bilateral forms. The right-to-left, male-to-female and unilateral-to-bilateral ratios were 2.2:1, 1.9:1 and 35.8:1 respectively. The mean age at surgery was 22.3 ± 11.8 months (range, 8–80). The proposed classification system allowed the classification of all CTDs (n = 221). Specifically, 53 fingers were classified as Type I (24%), 136 as Type II (61.5%), 21 as Type III (9.5%), and 11 as Type IV (5%).ConclusionThe proposed system is based on radiographic pathoanatomy and complements that of Wu et al. by identifying four distinct subtypes of deformity. It has the potential to improve inter-professional communication and guide surgery in patients with Wu et al. type C3 CTD. However, our results are preliminary and further research is needed to validate them.Level of evidenceIII.

Evaluation of Fetal Heart Using Fetal Heart Quantification (fetalHQ) Technique in an Indian Cohort.

To evaluate the intra- and interobserver reproducibility of parameters used to determine cardiac morphometry and deformation using FetalHQ in Indian population. Two operators blinded to each other performed FetalHQ analysis independently on 35 normal fetuses of gestational age between 18 + 0 and 37 + 0 weeks and days. Intra- and interobserver correlation coefficient and limits of agreement were ascertained for parameters obtained from HQ analysis. Excellent reproducibility (ICC > 0.9) was observed for global morphometric parameters. Ejection fraction, stroke volume, stroke volume/kg demonstrated excellent reliability (ICC > 0.9), cardiac output, fractional area change showed a lower correlation (ICC < 0.8), and right and left ventricular global strain showed no correlation. Twenty-four segment sphericity index of left ventricle (LV) and right ventricle (RV) showed low to moderate correlation (LV-ICC 0.48-0.79; RV-ICC 0.43-0.82). Fractional shortening (FS) showed poor intraobserver reliability in RV. FetalHQ provides reliable estimates of the global cardiac morphometry but not for global cardiac strain. Regional transverse contractility represented by FS has poor correlation in right ventricle, especially in the apical region, possibly due to moderator band. Nevertheless, it is a promising tool which requires technical advancements and validation to improve its accuracy and reliability.

Improving agreement in assessing subtrochanteric fracture healing among orthopedic surgeons using the Radiographic Union Score for Hip (RUSH)

BackgroundPrompt identification of fracture healing is crucial for medical decision-making and clinical research. This study aims to assess the effectiveness of the Radiographic Union Score for Hip (RUSH) in subtrochanteric fractures and determine the optimal scoring threshold for fracture healing.MethodsWe obtained 94 sets of X-ray films from the postoperative follow-up of 35 patients who underwent intramedullary nail fixation for subtrochanteric fractures. Six orthopedic trauma surgeons evaluated the imaging data and determined fracture healing based on subjective judgment. They then scored the X-ray images using the RUSH form. After four weeks, the same observers re-evaluated 47 randomly selected sets of radiographs. Subsequently, the observers and study designer conducted a consensus meeting where they agreed on whether the fractures had healed. We used Fleiss kappa to evaluate agreement among observers based on subjective impressions, and the intraclass correlation coefficient assessed RUSH score consistency. Regression analysis examined the relationship between scores and fracture healing consensus using a receiver operator characteristic (ROC) curve.ResultsBased on overall impressions, the agreement level among orthopedic trauma surgeons for determining the healing status of subtrochanteric fractures was moderate (Kappa = 0.564, 95% CI: 0.511–0.616). However, utilizing the RUSH scoring system can improve the consistency to a substantial level of agreement (ICC = 0.748, 95% CI: 0.663–0.817). Regarding intraobserver reliability, there were significant differences among orthopedic trauma surgeons in judging fracture healing based on overall impressions. However, using the RUSH scoring form, the attending group achieved better intraobserver consistency than the resident group. Regression analysis and ROC curve analysis revealed a strong correlation between the RUSH total score, cortical bone score, cancellous bone score, and consensus on fracture healing. The AUC values are 0.769 (95% CI: 0.670–0.868), 0.779 (95% CI: 0.681–0.876), and 0.771 (95% CI: 0.674–0.867), respectively.ConclusionsOur study highlights the effectiveness of the RUSH scoring system in enhancing interobserver agreement and intraobserver consistency when evaluating subtrochanteric fracture healing in orthopedic trauma surgeons. We propose setting 21 points as the threshold for the simplified RUSH scoring system to determine fracture healing. This system includes only eight items related to cortical bone, with a total score of 24 points.

Comparison of the AO/OTA 1996/2007 and 2018 pelvic ring fracture classifications.

Pelvic ring fractures may present with relevant mechanical and haemodynamic instability. Classifications of the bony or ligamentous injuries of the pelvic ring are well established. The most common classifications used analyse the injury mechanisms and the resulting instability of the pelvic ring structure. Fracture classifications should be simple and easy to use, comprehensive, andradiographically and anatomically based, resulting in a hierarchical alphanumeric order of types and subtypes and thereby allow adequate treatment decisions based on a high degree of inter- and intraobserver reliability. In 2018 a new AO/OTA pelvic ring fracture and dislocationclassification was published that combined the most commonly used "historical" classification schemes, e.g. the Tile/AO classification and the classification according to Young and Burgess. Compared with these older classifications, several relevant changes were integrated in the 2018 edition. The changes between the AO/OTA 1996/2007 and 2018 classifications were analysed in detail. Overall, several problems were identified regarding the type-B pelvic ring injury classification. These changes may result in difficulties in classifying pelvic ring injuries and thereby prevent relevant comparisons between former and future clinical studies on pelvic injuries.Level of Evidence: V.

Performance of ultrasound-guided attenuation parameter and 2D shear wave elastography in patients with metabolic dysfunction-associated steatotic liver disease.

To assess the performance and the reproducibility of ultrasound-guided attenuation parameter (UGAP) and two-dimensional shear wave elastography (2D-SWE) in patients with biopsy-proven metabolic dysfunction-associated steatotic liver disease (MASLD). This study included consecutive adult patients with MASLD who underwent ultrasound with UGAP, 2D-SWE and percutaneous liver biopsy. The median values of 12 consecutive UGAP measurements were acquired by two independent radiologists (R1 and R2). Hepatic steatosis was graded by liver biopsy as: (0) < 5%; (1) 5-33%; (2) > 33-66%; (3) > 66%. Areas under the curve (AUCs) were calculated to determine the diagnostic performance. Inter- and intra-observer reliability was assessed with intraclass correlation coefficient (ICC). A hundred patients (median age 55.0 years old) with MASLD were prospectively enrolled. At histopathology, 70 and 42 patients had grade ≥ 2 and 3 steatosis, respectively. Median UGAP was 0.78 dB/cm/MHz (IQR/Med: 5.55%). For the diagnosis of grade ≥ 2 steatosis, the AUCs of UGAP were 0.828 (95% CI: 0.739, 0.896) for R1 and 0.779 (95% CI: 0.685, 0.856) for R2. The inter- and intra-operator reliability of UGAP were excellent, with an ICC of 0.92 (95% CI: 0.87-0.95) and 0.95 (95% CI: 0.92-0.96), respectively. The median liver stiffness was 6.76 kPa (IQR/Med: 16.30%). For the diagnosis of advanced fibrosis, 2D-SWE had an AUC of 0.862 (95% CI: 0.757, 0.934), and the optimal cutoff value was > 6.75 kPa with a sensitivity of 80.6% and a specificity of 75.7%. UGAP and 2D-SWE provide a good performance for the staging of steatosis and fibrosis in patients with MASLD with an excellent intra-operator reliability of UGAP. Question How well do ultrasound-guided attenuation parameter (UGAP) and two-dimensional shear wave elastography (2D-SWE) perform for quantifying hepatic steatosis and fibrosis? Findings UGAP had a maximum AUC of 0.828 for the diagnosis of grade ≥ 2 steatosis, and 2D-SWE had an AUC of 0.862 for diagnosing advanced fibrosis. Clinical relevance UGAP and 2D-SWE allow rapid, reproducible, and accurate quantification of hepatic steatosis and fibrosis that can be used for the noninvasive assessment of patients with metabolic dysfunction-associated steatotic liver disease.

The inferior sacral iliac line as a horizontal reference plane in paediatric pelvic radiographs.

While often used, Hilgenreiner's line may not always be a reliable reference plane following triple innominate pelvic osteotomy or trauma to the triradiate cartilage. The inferior sacral-iliac line is a horizontal line connecting the sclerotic corners of the inferior sacral-iliac joints. This is a consistent landmark in the ossifying infant pelvis as well as the fully developed adult pelvis. The goal of this study was to determine if there is a difference in measurements between the inferior sacral-iliac line and Hilgenreiner's line in order to identify an alternative horizontal reference plane. 3 reviewers (fellowship-trained paediatric orthopaedic surgeon, junior orthopaedic resident, senior orthopaedic resident) reviewed 100 paediatric non-osteotomized pelvises. The difference between Hilgenreiner's line and the inferior sacral-iliac line were measured and reported. Measurements were repeated a minimum of 48 hours apart, resulting in 600 comparisons between Hilgenreiner's line and the inferior sacral-iliac line. The standard error of measurement was calculated to assess the variation in measurements between each individual observer and the group as a whole. The mean standard error of measurement between Hilgenreiner's line and the inferior sacral-iliac line was 0.44° (95% CI, ± 0.86). Reviewers 1-3 demonstrated a mean standard error of measurement of 0.38, 0.28, and 0.35 (95% CI, ± 0.74, 0.55, and 0.86) respectively. There was no statistically significant difference between reviewers (p > 0.05). Intra-observer reliability for reviewers 1, 2, and 3 was 0.64 (0.47-0.76), 0.75 (0.63-0.83), and 0.54 (0.32-0.69) respectively, with an inter-observer reliability of 0.42 (0.20-0.60) degrees. In this proof-of-concept study, the inferior sacral-iliac line was found to be an appropriate alternative to Hilgenreiner's line that is easily identifiable for all levels of orthopaedic training. Future inferior sacral-iliac line studies should demonstrate the reliability of multiple acetabular measurements, both pre- and post-osteotomy.

No clinically relevant relationship between different quantitative measurement methods of the lateral femoral condyle morphology on lateral radiographs in anterior cruciate ligament-injured patients.

To clarify whether different methods of quantifying lateral femoral condyle (LFC) bone morphology as risk factors for anterior cruciate ligament (ACL) injury on lateral radiographs should be considered as individual risk factors and to assess inter- and intraobserver reliability. We retrospectively reviewed 487 patients undergoing primary ACL reconstruction at our institution. Routine lateral radiographs of the injured knees were utilized to measure the following parameters: LFC ratio (LFCR), height of LFC to anteroposterior diameter ratio (HAPR), femur tibia size ratio (FTSR), tibia to posterior femoral condyle ratio (TPFCR) and Porto ratios (XY/AB; B/AB; B/XY). Malrotated radiographs were excluded. Pearson's correlation coefficients were used to identify relationships. Intraclass correlation coefficients were calculated for inter- and intraobserver reliability for two raters. Fifty-eight patients were included. Means and standard deviations for LFCR were 63.7% ± 2.8%, HAPR 0.35 ± 0.02, FTSR 1.23 ± 0.07, TPFCR 2.99 ± 0.28, XY/AB 0.41 ± 0.08, B/AB 1.20 ± 0.06 and B/XY 3.05 ± 0.58. Significant correlations were observed between FTSR and XY/AB (r = 0.425), B/AB (r = 0.582) and TPFCR (r = -0.326), between XY/AB and HAPR (r = -0.309) and B/XY (r = -0.933) and between TPFCR and B/AB (r = 0.302). Intraobserver agreement was excellent for LFCR, HAPR, FTSR, TPFCR and B/AB and good for XY/AB and B/XY. Interobserver agreement varied from poor for XY/AB and B/XY, good for HAPR, B/AB, FTSR and TPFCR to excellent for LFCR. Different methods of quantifying LFC bone morphology should be considered as individual risk factors, characterized by good to excellent intraobserver reliability, but highly variable interobserver reliability. Level III.

GNRB® Knee Arthrometer: Inter- and Intra-observer Reliability and Learning Curve.

Background Diagnosing anterior cruciate ligament rupture is challenging, particularly due to the subjective nature of clinical laxity assessments. Objective evaluation methods are necessary for consistency and publication in clinical research. This study aims to assess the reproducibility of the GNRB® knee arthrometer (GeNouRoB, Laval, France) across different examiners and to examine the associated learning curve for a junior examiner. Methods Anterior translation measurements were conducted on 20 healthy knees using the GNRB arthrometer. Two examiners, a senior and a junior, performed the measurements independently and were blinded to each other's results. Measurements were taken at two different push forces (134 N and 200 N). The study evaluated inter- and intra-observer reproducibility using Cohen's kappa coefficient and the intraclass correlation coefficient (ICC). The junior examiner also performed a thirdseries of measurements to assess the learning curve. Results The senior examiner demonstrated excellent reproducibility with an ICC greater than 0.75 for all measurements. The junior examiner's reproducibility varied from fair to good, with an ICC ranging from 0.45 to 0.75. Inter-observer reproducibility between the senior and junior examiners was excellent (ICC >0.75). Notably, the junior examiner's reproducibility improved to an excellent level (ICC >0.75) during the second series of measurements. Conclusion The GNRB system provides a reproducible method for evaluating anterior knee laxity across different examiners. A learning curve of approximately 20 knees is sufficient for a junior examiner to achieve statistically excellent reproducibility.