Clinical assessment of tibial torsion differences. Do we always need a computed tomography?
Clinical exam
Computed tomography
Reliability
Tibial torsion
Journal
European journal of trauma and emergency surgery : official publication of the European Trauma Society
ISSN: 1863-9941
Titre abrégé: Eur J Trauma Emerg Surg
Pays: Germany
ID NLM: 101313350
Informations de publication
Date de publication:
Aug 2022
Aug 2022
Historique:
received:
06
08
2021
accepted:
17
01
2022
pubmed:
12
2
2022
medline:
11
8
2022
entrez:
11
2
2022
Statut:
ppublish
Résumé
Tibial torsional malalignment presents a well-known complication of intramedullary nailing for tibial shaft fractures. Objective of this study was to investigate the ability to clinically assess tibial torsion differences. Computed Tomography (CT) was used here as the gold standard. Further, intra- and inter-observer reliability of the clinical examination, and radiological measurements were calculated. Fifty-one patients with torsion-difference CTs, obtained for various reasons, were asked to kneel on an examination couch with free hanging feet. All patients are positioned with 90° flexed knee and neutral ankle. A picture of the lower extremities was obtained from the back of the patient. Two blinded orthopedic surgeons were asked to look at the pictures and measure the tibial torsion with a digital goniometer, based on the axis of the femur in relation to the second ray of the foot. To determine the intra-observer variation, the torsional angles were calculated again after 4 weeks. To be able to compare values, two blinded radiologists calculated torsional differences based on computed tomography. All patients were able to be positioned for clinical assessment (n = 51). Clinical assessment of torsional difference revealed 4.55° ± 6.85 for the first, respectively, 4.55° ± 7.41 for the second investigator. The second measurement of the first investigator revealed a value of 4.57° ± 6.9. There was a good intra-observer agreement for clinical assessment (ICC 0.993, p < 0.001). Also, the inter-observer agreement showed a good inter-observer agreement (ICC 0.949, p < 0.001). Evaluation of radiological inter-observer assessment could also show a good inter-observer agreement (ICC 0.922, p < 0.001). The clinical method showed a good correlation to the CT method (0.839, p < 0.001). Additionally, the Bland-Altman plot was used to compare graphically both measurement techniques, which proved the agreement. In summary, computed tomography-assisted measurement of tibial torsion and clinical assessment correlated significantly good. In addition to that, clinical measurement has a good intra- and inter-observer reliability. Clinical examination is a reliable and cost-effective tool to detect mal-torsion and should be part of the repertoire of every surgeon.
Sections du résumé
BACKGROUND
BACKGROUND
Tibial torsional malalignment presents a well-known complication of intramedullary nailing for tibial shaft fractures.
PURPOSE
OBJECTIVE
Objective of this study was to investigate the ability to clinically assess tibial torsion differences. Computed Tomography (CT) was used here as the gold standard. Further, intra- and inter-observer reliability of the clinical examination, and radiological measurements were calculated.
METHODS
METHODS
Fifty-one patients with torsion-difference CTs, obtained for various reasons, were asked to kneel on an examination couch with free hanging feet. All patients are positioned with 90° flexed knee and neutral ankle. A picture of the lower extremities was obtained from the back of the patient. Two blinded orthopedic surgeons were asked to look at the pictures and measure the tibial torsion with a digital goniometer, based on the axis of the femur in relation to the second ray of the foot. To determine the intra-observer variation, the torsional angles were calculated again after 4 weeks. To be able to compare values, two blinded radiologists calculated torsional differences based on computed tomography.
RESULTS
RESULTS
All patients were able to be positioned for clinical assessment (n = 51). Clinical assessment of torsional difference revealed 4.55° ± 6.85 for the first, respectively, 4.55° ± 7.41 for the second investigator. The second measurement of the first investigator revealed a value of 4.57° ± 6.9. There was a good intra-observer agreement for clinical assessment (ICC 0.993, p < 0.001). Also, the inter-observer agreement showed a good inter-observer agreement (ICC 0.949, p < 0.001). Evaluation of radiological inter-observer assessment could also show a good inter-observer agreement (ICC 0.922, p < 0.001). The clinical method showed a good correlation to the CT method (0.839, p < 0.001). Additionally, the Bland-Altman plot was used to compare graphically both measurement techniques, which proved the agreement.
CONCLUSION
CONCLUSIONS
In summary, computed tomography-assisted measurement of tibial torsion and clinical assessment correlated significantly good. In addition to that, clinical measurement has a good intra- and inter-observer reliability. Clinical examination is a reliable and cost-effective tool to detect mal-torsion and should be part of the repertoire of every surgeon.
Identifiants
pubmed: 35146543
doi: 10.1007/s00068-022-01884-4
pii: 10.1007/s00068-022-01884-4
pmc: PMC9360086
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3229-3235Informations de copyright
© 2022. The Author(s).
Références
Lancet. 1986 Feb 8;1(8476):307-10
pubmed: 2868172
Injury. 2018 Oct;49(10):1895-1900
pubmed: 30097311
Lancet. 1995 Oct 21;346(8982):1085-7
pubmed: 7564793
Eur J Trauma Emerg Surg. 2021 Jan 2;:
pubmed: 33388784
J Trauma. 2005 Nov;59(5):1219-23; discussion 1223
pubmed: 16385303
N Engl J Med. 2007 Nov 29;357(22):2277-84
pubmed: 18046031
Foot Ankle Int. 2002 Feb;23(2):102-6
pubmed: 11858328
Indian J Orthop. 2012 May;46(3):312-6
pubmed: 22719118
J Pak Med Assoc. 2016 Oct;66(Suppl 3)(10):S106-S108
pubmed: 27895371
J Bone Joint Surg Am. 2020 Apr 1;102(7):582-591
pubmed: 31977824
Rofo. 2004 Sep;176(9):1278-84
pubmed: 15346263
Injury. 1983 Jul;15(1):38-40
pubmed: 6885145
Injury. 2016 Oct;47(10):2312-2314
pubmed: 27461778
Int Orthop. 2007 Oct;31(5):709-14
pubmed: 17160683
Injury. 1998;29 Suppl 3:C29-39
pubmed: 10341895
Unfallchirurgie. 1993 Jun;19(3):145-57
pubmed: 8333078
Acta Orthop Scand. 1989 Jun;60(3):330-3
pubmed: 2750510
J Orthop Sci. 2015 Jul;20(4):695-701
pubmed: 25790936
Coll Antropol. 2009 Mar;33(1):37-41
pubmed: 19408601
J Orthop Trauma. 2004 Aug;18(7):397-402
pubmed: 15289683
J Orthop Trauma. 1991;5(3):247-54
pubmed: 1941305
J Comput Assist Tomogr. 1985 May-Jun;9(3):466-70
pubmed: 3989039
Skeletal Radiol. 2012 Mar;41(3):305-11
pubmed: 21560009
J Orthop Trauma. 2004 Aug;18(7):403-9
pubmed: 15289684
AJR Am J Roentgenol. 1997 Mar;168(3):791-4
pubmed: 9057536
AJR Am J Roentgenol. 2001 Feb;176(2):289-96
pubmed: 11159059
J Bone Joint Surg Am. 1995 Sep;77(9):1331-4
pubmed: 7673281
Stat Med. 2008 Feb 28;27(5):778-80
pubmed: 17907247
Injury. 1999 Sep;30(7):467-70
pubmed: 10707213
Clin Orthop Relat Res. 1991 Nov;(272):208-12
pubmed: 1934735
J Child Orthop. 2012 Oct;6(5):391-6
pubmed: 24082954
J Bone Joint Surg Am. 2012 Nov 21;94(22):2033-9
pubmed: 23172320
Foot Ankle. 1984 Jan-Feb;4(4):180-4
pubmed: 6714858
J Orthop Trauma. 2011 Dec;25(12):736-41
pubmed: 21904230
Arch Orthop Trauma Surg. 2014 Oct;134(10):1381-6
pubmed: 25099077
Z Orthop Ihre Grenzgeb. 1981 Oct;119(5):525-34
pubmed: 7314828