This Article Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal My Folders Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Whelan, D. B. Articles by Schemitsch, E. H. Search for Related Content PubMed PubMed Citation Articles by Whelan, D. B. Articles by Schemitsch, E. H.

Interobserver and intraobserver variation in the assessment of the healing of tibial fractures after intramedullary fixation

¹ Division of Orthopaedic Surgery, St Michael’s Hospital, 55 Queen Street East, Suite 800, Toronto, Ontario, Canada M5C 1R6.
² Department of Epidemiology and Biostatistics, McMaster University, Room 2C12, 1200 Main Street West, Hamilton, Ontario, Canada, L8N 3Z5.
³ Division of Orthopaedic Surgery, Sunnybrook and Women’s College, Health Sciences Centre, 2075 Bayview Avenue, Room MG-365, Toronto, Ontario, Canada M4N 3M5.

Correspondence should be sent to Dr E. H. Schemitsch.

The reliability of the radiological assessment of the healing of tibial fractures remains undetermined. We examined the inter- and intraobserver agreement of the healing of such fractures among four orthopaedic trauma surgeons who, on two separate occasions eight weeks apart, independently assessed the radiographs of 30 patients with fractures of the tibial shaft which had been treated by intramedullary fixation. The radiographs were selected from a database to represent fractures at various stages of healing. For each radiograph, the surgeon scored the degree of union, quantified the number of cortices bridged by callus or with a visible fracture line, described the extent and quality of the callus, and provided an overall rating of healing.

The interobserver chance-corrected agreement using a quadratically weighted kappa () statistic in which values of 0.61 to 0.80 represented substantial agreement were as follows: radiological union scale ( = 0.60); number of cortices bridged by callus ( = 0.75); number of cortices with a visible fracture line ( = 0.70); the extent of the callus ( = 0.57); and general impression of fracture healing ( = 0.67). The intraobserver agreement of the overall impression of healing ( = 0.89) and the number of cortices bridged by callus ( = 0.82) or with a visible fracture line ( = 0.83) was almost perfect.

There are no validated scales which allow surgeons to grade fracture healing radiologically. Among those examined, the number of cortices bridged by bone appears to be a reliable, and easily measured radiological variable to assess the healing of fractures after intramedullary fixation.