title: Quantifying tibial plafond fracture severity: absorbed energy and fragment displacement agree with clinical rank ordering.
abstract: The energy of producing a fracture is considered one of the most important factors relating to injury severity, prognosis, and risk of complications, yet there has been no objective way to measure this important variable. The purpose of this study was to compare assessments of fracture severity made using new objective computed tomography (CT)-based methods versus the expert opinion of experienced orthopedic traumatologists. Fracture energy, fragment displacement, and soft tissue swelling were quantified in twenty tibial plafond fractures by analyzing injury CT scans. Three experienced orthopedic traumatologists then independently performed a rank order analysis of fracture severity, using plain radiographs. The concordance among the three clinicians ranged from 87% to 91%. Objective fracture severity measurements made with the CT algorithm agreed well with the clinical assessments (fracture energy concordance from 73% to 76%, fragment displacement from 82% to 89%, and soft tissue swelling from 61% to 65%). These are the first objective, CT-based measures of fracture severity. With further refinement, this conceptually novel method has the potential to serve as a valuable tool to provide objective measurement of fracture severity, allowing one to control for this previously confounding variable in large multicenter studies.
authors.affiliation: Department of Orthopaedics and Rehabilitation, The University of Iowa, 2181 Westlawn Building, Iowa City, Iowa 52242, USA. don-anderson@uiowa.edu
authors.forename: Donald D
authors.initials: DD
authors.lastname: Anderson
authors.forename: Teresa
authors.initials: T
authors.lastname: Mosqueda
authors.forename: Thaddeus
authors.initials: T
authors.lastname: Thomas
authors.forename: Evan L
authors.initials: EL
authors.lastname: Hermanson
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Brown
authors.forename: J Lawrence
authors.initials: JL
authors.lastname: Marsh
mesh_terms: D000328:Adult; D004487:Edema / Q000000981:diagnostic imaging / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D013314:Stress, Mechanical; D013978:Tibial Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000503:physiopathology; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000706:statistics & numerical data; D015599:Trauma Severity Indices