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Intraoperative Physical Examination for Diagnosis of Interosseous Ligament Rupture-Cadaveric Study
Amir Reza Kachooei1, Michael Rivlin2, Fei Wu3
1Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
The Journal of Hand Surgery
|August 2, 2015
Summary
Physician diagnosis of interosseous ligament (IOL) rupture using push-pull and lateral pull tests in cadavers showed fair reliability and 70% accuracy. Examiner experience did not impact diagnostic accuracy for IOL injuries.
Area of Science:
- Orthopedic surgery
- Anatomy
- Diagnostic reliability
Background:
- Interosseous ligament (IOL) rupture can complicate elbow fracture-dislocations.
- Accurate diagnosis is crucial for successful surgical outcomes.
Purpose of the Study:
- To assess the intraobserver and interobserver reliability of diagnosing interosseous ligament (IOL) rupture.
- To evaluate diagnostic accuracy using specific clinical maneuvers in a cadaver model.
Main Methods:
- 12 fresh frozen cadavers underwent radial head osteotomy and soft tissue manipulation.
- Four injury groups were created: intact or disrupted IOL and triangular fibrocartilage complex (TFCC).
- Ten physicians evaluated limbs using radius pull-push and lateral pull tests, classifying injuries before and after randomization.
Main Results:
- Interobserver reliability for IOL injury diagnosis was fair; intraobserver reliability was moderate.
- Overall agreement for all four injury groups was fair across both examination rounds.
- Sensitivity, specificity, and accuracy were approximately 70%; positive likelihood ratio was 2.2.
Conclusions:
- Intraoperative tests for IOL rupture in cadavers demonstrate fair reliability and 70% accuracy.
- Physician experience level did not influence the accuracy of diagnosing intact versus disrupted IOL.
- Accurate diagnosis of IOL disruption is vital to prevent surgical failures in elbow trauma.
