title: Interpretation of Post-operative Distal Humerus Radiographs After Internal Fixation: Prediction of Later Loss of Fixation.
abstract: OBJECTIVE
  Stable fixation of distal humerus fracture fragments is necessary for adequate healing and maintenance of reduction. The purpose of this study was to measure the reliability and accuracy of interpretation of postoperative radiographs to predict which implants will loosen or break after operative treatment of bicolumnar distal humerus fractures. We also addressed agreement among surgeons regarding which fracture fixation will loosen or break and the influence of years in independent practice, location of practice, and so forth.
  
  
  METHODS
  A total of 232 orthopedic residents and surgeons from around the world evaluated 24 anteroposterior and lateral radiographs of distal humerus fractures on a Web-based platform to predict which implants would loosen or break. Agreement among observers was measured using the multi-rater kappa measure.
  
  
  RESULTS
  The sensitivity of prediction of failure of fixation of distal humerus fracture on radiographs was 63%, specificity was 53%, positive predictive value was 36%, the negative predictive value was 78%, and accuracy was 56%. There was fair interobserver agreement (κ = 0.27) regarding predictions of failure of fixation of distal humerus fracture on radiographs. Interobserver variability did not change when assessed for the various subgroups.
  
  
  CONCLUSIONS
  When experienced and skilled surgeons perform fixation of type C distal humerus fracture, the immediate postoperative radiograph is not predictive of fixation failure. Reoperation based on the probability of failure might not be advisable.
  
  
  METHODS
  Diagnostic III.
authors: Orthopaedic Hand and Upper Extremity Service, Harvard Medical School, Massachusetts General Hospital, Boston, MA.
authors: Femke M A P
authors: FMAP
authors: Claessen
authors: Orthopaedic Hand and Upper Extremity Service, Harvard Medical School, Massachusetts General Hospital, Boston, MA.
authors: Nicky
authors: N
authors: Stoop
authors: Orthotrauma Research Center Amsterdam, University of Amsterdam Orthopaedic Residency Program, Amsterdam, The Netherlands.
authors: Job N
authors: JN
authors: Doornberg
authors: Orthotrauma Research Center Amsterdam, University of Amsterdam Orthopaedic Residency Program, Amsterdam, The Netherlands.
authors: Thierry G
authors: TG
authors: Guitton
authors: Shoulder and Elbow Unit, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
authors: Michel P J
authors: MPJ
authors: van den Bekerom
authors: Orthopaedic Hand and Upper Extremity Service, Harvard Medical School, Massachusetts General Hospital, Boston, MA. Electronic address: david.ring@austin.utexas.edu.
authors: David
authors: D
authors: Ring
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004551:Elbow Joint / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology*; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D015601:Injury Severity Score; D008297:Male; D015588:Observer Variation; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011859:Radiography / Q000379:methods; D016059:Range of Motion, Articular / Q000502:physiology; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D000092464:Elbow Injuries
keywords: Interobserver study; distal humerus fracture; elbow trauma