Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Variation in radial head fracture treatment recommendations in terrible triad injuries is not influenced by viewing two-dimensional computed tomography

  • Eric M. Perloff (Department of Orthopedic Surgery, Albany Medical Center) ;
  • Tom J. Crijns (Department of Surgery and Perioperative Care Dell Medical School, University of Texas Austin) ;
  • Casey M. O'Connor (Department of Orthopedic Surgery, Albany Medical Center) ;
  • David Ring (Department of Surgery and Perioperative Care Dell Medical School, University of Texas Austin) ;
  • Patrick G. Marinello (Department of Orthopedic Surgery, Albany Medical Center) ;
  • Science of Variation Group (Science of Variation Group)
  • Received : 2022.11.09
  • Accepted : 2023.01.14
  • Published : 2023.06.01
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Abstract

Background: We analyzed association between viewing two-dimensional computed tomography (2D CT) images in addition to radiographs with radial head treatment recommendations after accounting for patient and surgeon factors in a survey-based experiment. Methods: One hundred and fifty-four surgeons reviewed 15 patient scenarios with terrible triad fracture dislocations of the elbow. Surgeons were randomized to view either radiographs only or radiographs and 2D CT images. The scenarios randomized patient age, hand dominance, and occupation. For each scenario, surgeons were asked if they would recommend fixation or arthroplasty of the radial head. Multi-level logistic regression analysis identified variables associated with radial head treatment recommendations. Results: Reviewing 2D CT images in addition to radiographs had no statistical association with treatment recommendations. A higher likelihood of recommending prosthetic arthroplasty was associated with older patient age, patient occupation not requiring manual labor, surgeon practice location in the United States, practicing for five years or less, and the subspecialties "trauma" and "shoulder and elbow." Conclusions: The results of this study suggest that in terrible triad injuries, the imaging appearance of radial head fractures has no measurable influence on treatment recommendations. Personal surgeon factors and patient demographic characteristics may have a larger role in surgical decision making. Level of evidence: Level III, therapeutic case-control study.

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References

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