Interobserver Reliability in Imaging-Based Fracture Union Assessment-Two Systematic Reviews.

Area of Science:

• Orthopaedic Surgery
• Radiology
• Medical Imaging

Background:

• Assessing bone fracture union is crucial in orthopaedic trials.
• The specialty of observers and their agreement (interobserver reliability) can influence assessment outcomes.
• Previous studies have not comprehensively reviewed observer characteristics in fracture union assessment.

Purpose of the Study:

• To determine the specialties of observers in imaging-based bone fracture union assessments in orthopaedic trials.
• To review interobserver reliability in radiologic fracture union assessments between surgeons and radiologists.

Main Methods:

• Two systematic reviews (A, B) were conducted using MEDLINE and Embase databases.
• Review A focused on trials assessing radiologic fracture union (Jan 2016-Aug 2017).
• Review B focused on interobserver reliability studies (through Nov 2017), including fractures of the appendicular skeleton assessed by radiographs or CT.

Main Results:

• 33 of 48 trials (68%) did not report observer specialty; 13% reported surgeons only, 13% radiologists only.
• The median number of observers per trial was 1.
• 11 of 31 interobserver studies (35%) included both surgeons and radiologists; reliability was often unsatisfactory (<0.7).

Conclusions:

• Many orthopaedic trials do not specify observer specialties for fracture union assessment.
• Interobserver reliability in fracture union assessment is frequently suboptimal.
• Collaboration between surgeons and radiologists should be enhanced, with trials reporting reliability statistics and including multiple observers.