Upright vs. Supine Radiographs of Clavicle Fractures: Does Positioning Matter?
ABSTRACT To determine if clavicle fracture displacement and shortening are different between upright and supine radiographic examinations.
Combined retrospective and prospective comparative study.
Level I Trauma Center PATIENTS:: Forty-six patients (mean age 49 years, range 24-89 years) with an acute clavicle fracture were evaluated.
Standardized clavicle radiographs were obtained in both supine and upright positions for each patient. Displacement and shortening were measured and compared between the two positions.
One resident and three traumatologists classified the fractures and measured displacement and shortening. Data was aggregated and compared to ensure reliability with a two-way mixed intraclass correlation (ICC).
Fracture displacement was significantly greater when measured from upright radiographs (15.9±8.9mm) than from supine radiographs (8.4±6.6mm, p<0.001), representing an 89% increase in displacement with upright positioning. Forty-one percent of patients had greater than 100% displacement on upright, but not on supine radiographs. Compared to the uninjured side, 3.0±10.7mm of shortening was noted on upright radiographs and 1.3±9.5mm of lengthening on supine radiographs (p<0.001). The ICC was 0.82 (95% CI: 0.73-0.89) for OTA fracture classification, 0.81 (95% CI: 0.75-0.87) for vertical displacement, and 0.92 (95% CI: 0.88-0.95) for injured clavicle length, demonstrating very high agreement among evaluators.
Increased fracture displacement and shortening was observed on upright compared to supine radiographs. This suggests that upright radiographs may better demonstrate clavicle displacement and predict the position at healing if nonoperative treatment is selected.
- [Show abstract] [Hide abstract]
ABSTRACT: This paper presents a general statistical methodology for the analysis of multivariate categorical data arising from observer reliability studies. The procedure essentially involves the construction of functions of the observed proportions which are directed at the extent to which the observers agree among themselves and the construction of test statistics for hypotheses involving these functions. Tests for interobserver bias are presented in terms of first-order marginal homogeneity and measures of interobserver agreement are developed as generalized kappa-type statistics. These procedures are illustrated with a clinical diagnosis example from the epidemiological literature.Biometrics 04/1977; 33(1):159-74. DOI:10.2307/2529310 · 1.52 Impact Factor
- Clinical Orthopaedics and Related Research 01/1968; 58:29-42. DOI:10.1097/00003086-196805000-00006 · 2.88 Impact Factor
Article: Ununited fractures of the clavicle.[Show abstract] [Hide abstract]
ABSTRACT: We reviewed the cases of thirty-three patients with non-union of a clavicular fracture. The patients who seemed to have a predilection to non-union were seven who had sustained a refracture and twenty-one who had had severe trauma. Eleven patients had an atrophic non-union, and these lesions were less symptomatic than the hypertrophic non-unions in the series. Only three of the eleven patients with an atrophic non-union had an operation, compared with sixteen of the twenty-two patients with a hypertrophic non-union. The results in the nineteen patients who underwent the various surgical procedures (twenty-five operations) showed that the most successful procedure was internal fixation and bone-grafting. Even though union was achieved in twelve patients who were surgically treated, mild to moderate symptoms persisted in some.The Journal of Bone and Joint Surgery 08/1983; 65(6):773-8. · 4.31 Impact Factor