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Triplane Ankle Fractures in Children: Interrater and Intrarater Reliability of a Radiographic Classification System

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Triplane Ankle Fractures in Children: Interrater and Intrarater Reliability of a Radiographic Classification System
Zachary A. Stephan, BS, Emily A. Eismann, MS, and Charles T. Mehlman, DO, MPH Cincinnati Children´┐Żs Hospital Medical Center, Cincinnati, OH

Abstract: The objective was to assess reliability of the Rapariz triplane fracture classification system. Computed tomography (CT) was hypothesized to improve reliability and preoperative planning. Five raters classified 25 pediatric triplane fractures at two timepoints using plain radiographs alone, then with CTs. Ideal screw placement was drawn. CT improved interrater reliability of fracture classification from poor (k=0.17) with radiographs alone to moderate (k=0.41) but did not change intrarater reliability (k=0.57). CT changed their classification 46% of the time and their screw placement 41% of the time. CT is a useful adjunct to plain radiographs when classifying triplane fractures and planning treatment.

Objective: Discuss.
Objective Content: The learner will be able to discuss the need for preoperative CT scans as well as the low overall reliability of the Rapariz classification system.


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