SURGEON ACCURACY IN PREDICTION OF STABILITY OF POSTERIOR WALL ACETABULAR FRACTURES

This study aims to investigate surgeon accuracy in prediction of the stability of posterior wall acetabular fractures by comparing the gold standard of “examination under anesthesia” (EUA) findings to submitted estimations on the basis of radiograph and computed tomography (CT) imaging across a range of experience in Orthopaedic surgeons and trainees. Records of patients who underwent EUA after presenting with posterior wall acetabular fractures at 2 different institutions were pooled for data collection, totaling 50 cases. Radiographs, CT images, and information regarding the presence of a hip dislocation requiring procedural reduction were provided to participants for review. A survey was generated for submission of impressions of stability for each individual case and disseminated amongst Orthopaedic trainees and surgeons in practice The submissions of 11 respondents were analyzed. Mean accuracy was calculated to be 0.70 (SD 0.07). Sensitivity and specificity of respondents were 0.68 (SD 0.11) and 0.71 (SD 0.12) respectively. Positive predictive value and negative predictive value for respondents were 0.56 (SD 0.09) and 0.82 (SD 0.04) respectively. There was poor correlation of accuracy with years of experience with R2 calculated to be .0004 and poor agreement between observers with Kappa measurement of interobserver reliability of 0.46. Surgeons were not able to accurately predict stability of posterior wall acetabulum fractures in our study. This did not improve with increased experience. We recommend the continued use of examination under anesthesia in the diagnosis and treatment of these injuries.