OF-Pelvis classification of osteoporotic sacral and pelvic ring fractures
Abstract Objectives Osteoporotic fractures of the pelvis (OFP) are an increasing issue in orthopedics. Current classification systems (CS) are mostly CT-based and complex and offer only moderate to substantial inter-rater reliability (interRR) and intra-rater reliability (intraRR). MRI is thus gaini...
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2021
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oai:doaj.org-article:456afddebd594ec38f679f2e09f3e9272021-12-05T12:18:29ZOF-Pelvis classification of osteoporotic sacral and pelvic ring fractures10.1186/s12891-021-04882-61471-2474https://doaj.org/article/456afddebd594ec38f679f2e09f3e9272021-11-01T00:00:00Zhttps://doi.org/10.1186/s12891-021-04882-6https://doaj.org/toc/1471-2474Abstract Objectives Osteoporotic fractures of the pelvis (OFP) are an increasing issue in orthopedics. Current classification systems (CS) are mostly CT-based and complex and offer only moderate to substantial inter-rater reliability (interRR) and intra-rater reliability (intraRR). MRI is thus gaining importance as a complement. This study aimed to develop a simple and reliable CT- and MRI-based CS for OFP. Methods A structured iterative procedure was conducted to reach a consensus among German-speaking spinal and pelvic trauma experts over 5 years. As a result, the proposed OF-Pelvis CS was developed. To assess its reliability, 28 experienced trauma and orthopedic surgeons categorized 25 anonymized cases using X-ray, CT, and MRI scans twice via online surveys. A period of 4 weeks separated the completion of the first from the second survey, and the cases were presented in an altered order. While 13 of the raters were also involved in developing the CS (developing raters (DR)), 15 user raters (UR) were not deeply involved in the development process. To assess the interRR of the OF-Pelvis categories, Fleiss’ kappa (κF) was calculated for each survey. The intraRR for both surveys was calculated for each rater using Kendall’s tau (τK). The presence of a modifier was calculated with κF for interRR and Cohen’s kappa (κC) for intraRR. Results The OF-Pelvis consists of five subgroups and three modifiers. Instability increases from subgroups 1 (OF1) to 5 (OF5) and by a given modifier. The three modifiers can be assigned alone or in combination. In both surveys, the interRR for subgroups was substantial: κF = 0.764 (Survey 1) and κF = 0.790 (Survey 2). The interRR of the DR and UR was nearly on par (κF Survey 1/Survey 2: DR 0.776/0.813; UR 0.748/0.766). The agreement for each of the five subgroups was also strong (κF min.–max. Survey 1/Survey 2: 0.708–0.827/0.747–0.852). The existence of at least one modifier was rated with substantial agreement (κF Survey 1/Survey 2: 0.646/0.629). The intraRR for subgroups showed almost perfect agreement (τK = 0.894, DR: τK = 0.901, UR: τK = 0.889). The modifier had an intraRR of κC = 0.684 (DR: κC = 0.723, UR: κC = 0.651), which is also considered substantial. Conclusion The OF-Pelvis is a reliable tool to categorize OFP with substantial interRR and almost perfect intraRR. The similar reliabilities between experienced DRs and URs demonstrate that the training status of the user is not important. However, it may be a reliable basis for an indication of the treatment score.Bernhard W. UllrichKlaus J. SchnakeUlrich J. A. SpieglPhilipp SchenkThomas MendelLars BehrPhilipp BulaLaura B. FlüchtAlexander FranckErol GercekSebastian GrüningerPhilipp HartungCornelius JacobsSebastian KatscherFriederike KlaukeKatja LiepoldChristian W. MüllerMichael MüllerGeorg OsterhoffAxel PartenheimerStefan PiltzMarion RiehleDaniel SauerMax Joseph ScheyererPhilipp SchleicherGregor SchmeiserRené SchmidtMatti ScholzHolger SiekmannKai SprengelDietrich StoevesandtAkhil VerheydenVolker Zimmermannthe Spine Section of the German Society for Orthopaedics and TraumaBMCarticleSacralPelvic ringFractureOsteoporosisClassificationConsensus developmentDiseases of the musculoskeletal systemRC925-935ENBMC Musculoskeletal Disorders, Vol 22, Iss 1, Pp 1-10 (2021) |
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DOAJ |
| collection |
DOAJ |
| language |
EN |
| topic |
Sacral Pelvic ring Fracture Osteoporosis Classification Consensus development Diseases of the musculoskeletal system RC925-935 |
| spellingShingle |
Sacral Pelvic ring Fracture Osteoporosis Classification Consensus development Diseases of the musculoskeletal system RC925-935 Bernhard W. Ullrich Klaus J. Schnake Ulrich J. A. Spiegl Philipp Schenk Thomas Mendel Lars Behr Philipp Bula Laura B. Flücht Alexander Franck Erol Gercek Sebastian Grüninger Philipp Hartung Cornelius Jacobs Sebastian Katscher Friederike Klauke Katja Liepold Christian W. Müller Michael Müller Georg Osterhoff Axel Partenheimer Stefan Piltz Marion Riehle Daniel Sauer Max Joseph Scheyerer Philipp Schleicher Gregor Schmeiser René Schmidt Matti Scholz Holger Siekmann Kai Sprengel Dietrich Stoevesandt Akhil Verheyden Volker Zimmermann the Spine Section of the German Society for Orthopaedics and Trauma OF-Pelvis classification of osteoporotic sacral and pelvic ring fractures |
| description |
Abstract Objectives Osteoporotic fractures of the pelvis (OFP) are an increasing issue in orthopedics. Current classification systems (CS) are mostly CT-based and complex and offer only moderate to substantial inter-rater reliability (interRR) and intra-rater reliability (intraRR). MRI is thus gaining importance as a complement. This study aimed to develop a simple and reliable CT- and MRI-based CS for OFP. Methods A structured iterative procedure was conducted to reach a consensus among German-speaking spinal and pelvic trauma experts over 5 years. As a result, the proposed OF-Pelvis CS was developed. To assess its reliability, 28 experienced trauma and orthopedic surgeons categorized 25 anonymized cases using X-ray, CT, and MRI scans twice via online surveys. A period of 4 weeks separated the completion of the first from the second survey, and the cases were presented in an altered order. While 13 of the raters were also involved in developing the CS (developing raters (DR)), 15 user raters (UR) were not deeply involved in the development process. To assess the interRR of the OF-Pelvis categories, Fleiss’ kappa (κF) was calculated for each survey. The intraRR for both surveys was calculated for each rater using Kendall’s tau (τK). The presence of a modifier was calculated with κF for interRR and Cohen’s kappa (κC) for intraRR. Results The OF-Pelvis consists of five subgroups and three modifiers. Instability increases from subgroups 1 (OF1) to 5 (OF5) and by a given modifier. The three modifiers can be assigned alone or in combination. In both surveys, the interRR for subgroups was substantial: κF = 0.764 (Survey 1) and κF = 0.790 (Survey 2). The interRR of the DR and UR was nearly on par (κF Survey 1/Survey 2: DR 0.776/0.813; UR 0.748/0.766). The agreement for each of the five subgroups was also strong (κF min.–max. Survey 1/Survey 2: 0.708–0.827/0.747–0.852). The existence of at least one modifier was rated with substantial agreement (κF Survey 1/Survey 2: 0.646/0.629). The intraRR for subgroups showed almost perfect agreement (τK = 0.894, DR: τK = 0.901, UR: τK = 0.889). The modifier had an intraRR of κC = 0.684 (DR: κC = 0.723, UR: κC = 0.651), which is also considered substantial. Conclusion The OF-Pelvis is a reliable tool to categorize OFP with substantial interRR and almost perfect intraRR. The similar reliabilities between experienced DRs and URs demonstrate that the training status of the user is not important. However, it may be a reliable basis for an indication of the treatment score. |
| format |
article |
| author |
Bernhard W. Ullrich Klaus J. Schnake Ulrich J. A. Spiegl Philipp Schenk Thomas Mendel Lars Behr Philipp Bula Laura B. Flücht Alexander Franck Erol Gercek Sebastian Grüninger Philipp Hartung Cornelius Jacobs Sebastian Katscher Friederike Klauke Katja Liepold Christian W. Müller Michael Müller Georg Osterhoff Axel Partenheimer Stefan Piltz Marion Riehle Daniel Sauer Max Joseph Scheyerer Philipp Schleicher Gregor Schmeiser René Schmidt Matti Scholz Holger Siekmann Kai Sprengel Dietrich Stoevesandt Akhil Verheyden Volker Zimmermann the Spine Section of the German Society for Orthopaedics and Trauma |
| author_facet |
Bernhard W. Ullrich Klaus J. Schnake Ulrich J. A. Spiegl Philipp Schenk Thomas Mendel Lars Behr Philipp Bula Laura B. Flücht Alexander Franck Erol Gercek Sebastian Grüninger Philipp Hartung Cornelius Jacobs Sebastian Katscher Friederike Klauke Katja Liepold Christian W. Müller Michael Müller Georg Osterhoff Axel Partenheimer Stefan Piltz Marion Riehle Daniel Sauer Max Joseph Scheyerer Philipp Schleicher Gregor Schmeiser René Schmidt Matti Scholz Holger Siekmann Kai Sprengel Dietrich Stoevesandt Akhil Verheyden Volker Zimmermann the Spine Section of the German Society for Orthopaedics and Trauma |
| author_sort |
Bernhard W. Ullrich |
| title |
OF-Pelvis classification of osteoporotic sacral and pelvic ring fractures |
| title_short |
OF-Pelvis classification of osteoporotic sacral and pelvic ring fractures |
| title_full |
OF-Pelvis classification of osteoporotic sacral and pelvic ring fractures |
| title_fullStr |
OF-Pelvis classification of osteoporotic sacral and pelvic ring fractures |
| title_full_unstemmed |
OF-Pelvis classification of osteoporotic sacral and pelvic ring fractures |
| title_sort |
of-pelvis classification of osteoporotic sacral and pelvic ring fractures |
| publisher |
BMC |
| publishDate |
2021 |
| url |
https://doaj.org/article/456afddebd594ec38f679f2e09f3e927 |
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