Interobserver and intraobserver reliability of radiographic evidence of bone healing at osteotomy sites

Abstract

Plain radiographs are commonly used to evaluate the degree of bone healing after an osteotomy and the application of an external fixator. The purpose of the study was to assess intraobserver and interobserver reliability in determining bone healing, defined as bridging callus across three of four cortices, of osteotomy sites on radiographs. Substantial intraobserver reliability and a high intraobserver percentage agreement were found. Interobserver reliability was moderate and interobserver percentage agreement was less than half for agreement between all involved orthopaedic surgeons. The lower reliability across surgeons suggests that the determination of the extent of the bone healing is subjective.

Comparative Evalution of G bone (Hydroxyapatite) and G-Graft (Hydroxyapatite with Collagen) as Bone Graft Material in Mandibular III Molar Extraction Socket

“…The radiographic analysis showed that most of the third molar, 41.26% (26) were mesioangualr impactions, followed by vertical 22.22% (14), horizontal 20.63% (13), and distoangular 15.87% (10) [Table/ Fig-6,7]. +500 Celsius and this high temperature leaves only pure inorganic structure and thus removes the risk of transmission of any disease [6].…”

Femoral Lengthening with Lengthening over a Nail has Fewer Complications than Intramedullary Skeletal Kinetic Distraction

“…The distraction rate (in millimeters per day) was defined as the length of callus regeneration observed on the radiograph in millimeters divided by the time from the start to the end of distraction in days. A previous study [1] showed high intraobserver and interobserver reliability in determining bony union (defined as bridging callus across three of four cortices) of the osteotomy site on radiographs. The healing index was defined as the total treatment period with the fixator in situ, divided by the length of bone growth in centimeters.…”

Noninvasive Quantitative Assessment of Bone Healing After Distraction Osteogenesis

“…However, Anand et al [16] found inter-observer percentage agreement to be less than half between all involved orthopedic surgeons, supporting the observation that assessment of bone healing by radiography after distraction osteogenesis is subjective. Starr et al [16] investigated the reliability of using radiographs as a method to assess bone healing and determined that the variation in the assessment of the number of cortices was slightly better than chance.…”

“…Starr et al [16] investigated the reliability of using radiographs as a method to assess bone healing and determined that the variation in the assessment of the number of cortices was slightly better than chance. The authors concluded that low refracture rates after removal of an external fixator may be more an indicator of clinical judgment by experienced practitioners than the accuracy of using radiographic evaluation.…”

“…While using standard radiography is cheap and quick, the method of identifying three of four cortices does not produce reliable results. Anand et al [16] found inter-observer agreement to be less than 50% between all involved orthopedic surgeons, suggesting that the assessment of bone healing by radiographs is subjective. Starr et al [17] found that the decision to remove an external fixator based on radiographic assessment alone resulted in intra-observer and inter-observer variability Fig.…”