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The ballistic articular structure injury classification (BASIC) system: clarifying ballistic articular injuries.
Daniel Portney1, Hayden Baker2, Sarthak Aggarwal2
1Department of Orthopaedic Surgery, Duchossois Center for Advanced Medicine, University of Chicago, MC 3079, 5758 S. Maryland Avenue, Dept. 4B, Chicago, IL, 60637, USA. Daniel.portney@uchicagomedicine.org.
Summary
A new Ballistic Articular Injury Classification (BASIC) system was developed for knee, hip, and shoulder fractures. BASIC demonstrated moderate reliability and strong correlation with surgical decisions, offering a better alternative to current schemas for managing these complex injuries.
Area of Science:
- Orthopedic Surgery
- Trauma Surgery
- Radiology
Background:
- Ballistic fractures of the knee, hip, and shoulder present unique management challenges.
- Existing classification systems offer limited guidance for these specific injuries.
- A need exists for a reliable system to categorize and manage ballistic articular trauma.
Purpose of the Study:
- To develop a novel classification system for ballistic fractures of the knee, hip, and shoulder.
- To assess the reliability of this new system against current classifications.
- To determine the association between the new classification and surgical management decisions.
Main Methods:
- Retrospective review of a prospectively collected trauma database (147 patients, 169 fractures).
- Development of the Ballistic Articular Injury Classification (BASIC) system.
- Comparison of BASIC system reliability (interrater agreement) with the AO/OTA system using kappa statistics.
- Evaluation of BASIC's correlation with surgical treatment choices.
Main Results:
- The BASIC system, comprising five subgroups with soft tissue indicators, was developed.
- BASIC showed moderate interrater reliability (k=0.444) compared to fair for AO/OTA (k=0.373).
- The BASIC system demonstrated an 83% concurrence with surgical decisions, indicating strong correlation.
Conclusions:
- Conventional systems are inadequate for ballistic articular injuries.
- The BASIC system provides a pragmatic and reproducible classification for these injuries.
- BASIC has the potential to guide treatment decisions for knee, hip, and shoulder ballistic trauma.
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