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Inicio Revista Española de Cirugía Ortopédica y Traumatología (English Edition) Concordance in the radiological diagnosis of thoracolumbar spine fractures
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Vol. 59. Issue 4.
Pages 238-244 (July - August 2015)
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Vol. 59. Issue 4.
Pages 238-244 (July - August 2015)
Original Article
DOI: 10.1016/j.recote.2015.04.001
Concordance in the radiological diagnosis of thoracolumbar spine fractures
Concordancia en el diagnóstico radiológico de las fracturas del raquis toracolumbar
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152
M. Hirschfelda,
Corresponding author
miguelhirschfeld@gmail.com

Corresponding author.
, M. Rodrigueza, A.M. Cervána, J.A. Ortegaa, F. Rivas-Ruizb, E. Gueradoa
a Departamento de Traumatología y Cirugía Ortopédica, Hospital Universitario Costa del Sol, Universidad de Málaga, Marbella, Málaga, Spain
b Unidad de Investigación, Agencia Sanitaria Costa del Sol, Red de Investigación en Servicios de Salud y Enfermedades Crónicas REDISSEC, Marbella, Málaga, Spain
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Figures (7)
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Tables (5)
Table 1. Frequency and degree of consensus between observers on evaluating the “stability/instability” variable (kappa-Jacknife=0.17).
Table 2. Degree of concordance of observer 2 with regards to the reference value (multivariate logistic regression).
Table 3. Degree of concordance of observer 3 with regards to the reference value (multivariate logistic regression).
Table 4. Analysis of the independent variables included in the logistic regression (observer 2).
Table 5. Analysis of the independent variables included in the logistic regression (observer 3).
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Abstract
Introduction

Thoracolumbar spine fractures are frequent and severe. Early diagnosis and appropriate treatment to obtain good clinical results is essential, with many classifications being proposed for this purpose.

Objective

To determine the external validity of radiographic and computed tomography (CT) measurements for the most used classifications, and decide on the type of treatment required. The working hypothesis is the existence of external validity of radiographic measurements.

Material and method

A sample of patients with thoracolumbar fracture was selected. Three spine specialists and a resident performed measurements on anteroposterior and lateral radiographic images as well as coronal, sagittal and axial CT slices. Fractures were classified as stable or unstable, evaluating the degree of intra-and interobserver agreement based on a standard observer. Sagittal index of Farcy, lateral wedging, Beck Index, traumatic regional angulation and channel occupancy were studied.

Results

All indicators studied, except the lateral wedging, showed a high degree of concordance.

Conclusions

Instability determinants studied with radiographs and CT, which had obtained statistical significance, are reliable and accurate for the classification of thoracolumbar fractures and, therefore, to indicate an appropriate treatment.

Keywords:
Spine fractures
Diagnosis
Interobserver variability
Intraobserver variability
Resumen
Introducción

Las fracturas del raquis toracolumbar son muy frecuentes y graves, siendo imprescindible su diagnóstico precoz y tratamiento adecuado para obtener buenos resultados clínicos. Para este propósito se han descrito numerosas clasificaciones e índices.

Objetivo

Estudiar la validez externa de las mediciones radiográficas y de la tomografía computarizada (TC) para las clasificaciones más usadas y decidir el tipo de tratamiento que precisan. La hipótesis operativa consiste en la existencia de validez externa de las mediciones radiográficas.

Material y método

Se seleccionó una muestra de pacientes con fractura toracolumbar. Tres especialistas de raquis y un médico residente realizaron mediciones sobre imágenes radiográficas anteroposterior y lateral, así como sobre cortes coronales, sagitales y axiales de TC, clasificándose las fracturas como estables o inestables, evaluándose el grado de concordancia intra e interobservador, basados en un observador estándar. Se estudiaron las variables índice sagital de Farcy, acuñamiento lateral, índice de Beck, angulación regional traumática y ocupación del canal.

Resultados

Todos los indicadores estudiados, excepto el acuñamiento lateral, presentaron un alto grado de concordancia.

Conclusiones

Los determinantes de inestabilidad estudiados en radiografías simples y TC que han obtenido significación estadística son fiables y precisos para caracterizar las fracturas toracolumbares y, por tanto, para indicar un tratamiento adecuado.

Palabras clave:
Fracturas de raquis
Diagnóstico
Variabilidad interobservador
Variabilidad intraobservador

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