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Plain X-ray is insufficient for correct diagnosis of tibial shaft spiral fractures: a prospective trial
Purpose Tibial shaft spiral fractures and fractures of the distal third of the tibia (AO:42A/B/C and 43A) frequently occur with non-displaced posterior malleolus fractures (PM). This study investigated the hypothesis that plain X-ray is not sufficient for a reliable diagnosis of associated non-displ...
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Published in: | European journal of trauma and emergency surgery (Munich : 2007) 2023-12, Vol.49 (6), p.2339-2345 |
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container_title | European journal of trauma and emergency surgery (Munich : 2007) |
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creator | Lisitano, Leonard Röttinger, Timon Wiedl, Andreas Rau, Kim Helling, Sönke Cifuentes, Jairo Jehs, Bertram Härting, Mark Feitelson, Laura-Marie Gleich, Johannes Kiesl, Sophia Pfeufer, Daniel Neuerburg, Carl Mayr, Edgar Förch, Stefan |
description | Purpose
Tibial shaft spiral fractures and fractures of the distal third of the tibia (AO:42A/B/C and 43A) frequently occur with non-displaced posterior malleolus fractures (PM). This study investigated the hypothesis that plain X-ray is not sufficient for a reliable diagnosis of associated non-displaced PM fractures in tibial shaft spiral fractures.
Methods
50 X-rays showing 42A/B/C and 43A fractures were evaluated by two groups of physicians, each group was comprised of a resident and a fellowship-trained traumatologist or radiologist. Each group was tasked to make a diagnosis and/or suggest if further imaging was needed. One group was primed with the incidence of PM fractures and asked to explicitly assess the PM.
Results
Overall, 9.13/25 (SD ± 5.77) PM fractures were diagnosed on X-ray. If the posterior malleolus fracture was named or a CT was requested, the fracture was considered “detected”. With this in mind, 14.8 ± 5.95 posterior malleolus fractures were detected.
Significantly more fractures were diagnosed/detected (14 vs. 4.25/25;
p
|
doi_str_mv | 10.1007/s00068-023-02285-x |
format | article |
fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10728229</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2903101660</sourcerecordid><originalsourceid>FETCH-LOGICAL-c475t-7e0fcd8d2f489304c657edeb5825726cafc6c1af5b23265909d37f3dec5b1a83</originalsourceid><addsrcrecordid>eNp9kUtPxCAUhYnR-Bj9Ay4MiRs3VR6Ftm6MMb4SE124cEcohRHTKRVao__eO46Oj4ULAuR-93AuB6FdSg4pIcVRIoTIMiOMw2KlyF5X0CYtJc-qKqeryzPnG2grpSegiRRsHW3wgsmKk3wTTe9a7Tv8kEX9hn3Cvkujc9542w3YhYhNiNGaATdeT7uQAAkOD772usXpUbsBp95HuLiozTBGm46xxn0MqYc2_2LxEIHdRmtOt8nufO4TdH9xfn92ld3cXl6fnd5kJi_EkBWWONOUDXN5OTdopChsY2tRMgGejXZGGqqdqBlnUlSkanjheGONqKku-QSdLGT7sZ7ZxsAU4E310c90fFNBe_W70vlHNQ0vipKClYxVoHDwqRDD82jToGY-Gdu2urNhTGpO8SLn8LUTtP8HfQpj7GA8xSrCKaFSEqDYgjLwJylat3RDiZrnqBY5KshRfeSoXqFp7-ccy5av4ADgCyBBqZva-P32P7LvFZ6rUA</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2903101660</pqid></control><display><type>article</type><title>Plain X-ray is insufficient for correct diagnosis of tibial shaft spiral fractures: a prospective trial</title><source>Springer Nature</source><creator>Lisitano, Leonard ; Röttinger, Timon ; Wiedl, Andreas ; Rau, Kim ; Helling, Sönke ; Cifuentes, Jairo ; Jehs, Bertram ; Härting, Mark ; Feitelson, Laura-Marie ; Gleich, Johannes ; Kiesl, Sophia ; Pfeufer, Daniel ; Neuerburg, Carl ; Mayr, Edgar ; Förch, Stefan</creator><creatorcontrib>Lisitano, Leonard ; Röttinger, Timon ; Wiedl, Andreas ; Rau, Kim ; Helling, Sönke ; Cifuentes, Jairo ; Jehs, Bertram ; Härting, Mark ; Feitelson, Laura-Marie ; Gleich, Johannes ; Kiesl, Sophia ; Pfeufer, Daniel ; Neuerburg, Carl ; Mayr, Edgar ; Förch, Stefan</creatorcontrib><description>Purpose
Tibial shaft spiral fractures and fractures of the distal third of the tibia (AO:42A/B/C and 43A) frequently occur with non-displaced posterior malleolus fractures (PM). This study investigated the hypothesis that plain X-ray is not sufficient for a reliable diagnosis of associated non-displaced PM fractures in tibial shaft spiral fractures.
Methods
50 X-rays showing 42A/B/C and 43A fractures were evaluated by two groups of physicians, each group was comprised of a resident and a fellowship-trained traumatologist or radiologist. Each group was tasked to make a diagnosis and/or suggest if further imaging was needed. One group was primed with the incidence of PM fractures and asked to explicitly assess the PM.
Results
Overall, 9.13/25 (SD ± 5.77) PM fractures were diagnosed on X-ray. If the posterior malleolus fracture was named or a CT was requested, the fracture was considered “detected”. With this in mind, 14.8 ± 5.95 posterior malleolus fractures were detected.
Significantly more fractures were diagnosed/detected (14 vs. 4.25/25;
p
< 0.001/14.8 vs. 10.5/25;
p
< 0.001) in the group with awareness. However, there were significantly more false positives in the awareness group (2.5 vs. 0.5;
p
= 0.024). Senior physicians recognized slightly more fractures than residents (residents: 13.0 ± 7.79; senior physicians: 16.5 ± 3.70;
p
= 0.040). No significant differences were demonstrated between radiologists and trauma surgeons.
The inner-rater reliability was high with 91.2% agreement. Inter-rater reliability showed fair agreement (Fleiss-Kappa 0.274,
p
< 0.001) across all examiners and moderate agreement (Fleiss-Kappa 0.561,
p
< 0.001) in group 2.
Conclusion
Only 17% of PM fractures were identified on plain X-ray and awareness of PM only improved diagnosis by 39%. While experiencing improved accuracy, CT imaging should be included in a comprehensive examination of tibial shaft spiral fractures.
Level of evidence
II. Diagnostic prospective cohort study.
Trail registration number
DRKS00030075.</description><identifier>ISSN: 1863-9933</identifier><identifier>EISSN: 1863-9941</identifier><identifier>DOI: 10.1007/s00068-023-02285-x</identifier><identifier>PMID: 37269304</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Ankle Fractures - diagnostic imaging ; Ankle Fractures - surgery ; Critical Care Medicine ; Emergency Medicine ; Fractures ; Hip joint ; Humans ; Intensive ; Medical diagnosis ; Medicine ; Medicine & Public Health ; Original ; Original Article ; Orthopedics ; Prospective Studies ; Reproducibility of Results ; Retrospective Studies ; Sports Medicine ; Surgery ; Surgical Orthopedics ; Tibia ; Tibial Fractures - surgery ; Tomography, X-Ray Computed - methods ; Traumatic Surgery ; X-Rays</subject><ispartof>European journal of trauma and emergency surgery (Munich : 2007), 2023-12, Vol.49 (6), p.2339-2345</ispartof><rights>The Author(s) 2023</rights><rights>2023. The Author(s).</rights><rights>The Author(s) 2023. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c475t-7e0fcd8d2f489304c657edeb5825726cafc6c1af5b23265909d37f3dec5b1a83</citedby><cites>FETCH-LOGICAL-c475t-7e0fcd8d2f489304c657edeb5825726cafc6c1af5b23265909d37f3dec5b1a83</cites><orcidid>0000-0002-2194-4487</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,778,782,883,27907,27908</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37269304$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lisitano, Leonard</creatorcontrib><creatorcontrib>Röttinger, Timon</creatorcontrib><creatorcontrib>Wiedl, Andreas</creatorcontrib><creatorcontrib>Rau, Kim</creatorcontrib><creatorcontrib>Helling, Sönke</creatorcontrib><creatorcontrib>Cifuentes, Jairo</creatorcontrib><creatorcontrib>Jehs, Bertram</creatorcontrib><creatorcontrib>Härting, Mark</creatorcontrib><creatorcontrib>Feitelson, Laura-Marie</creatorcontrib><creatorcontrib>Gleich, Johannes</creatorcontrib><creatorcontrib>Kiesl, Sophia</creatorcontrib><creatorcontrib>Pfeufer, Daniel</creatorcontrib><creatorcontrib>Neuerburg, Carl</creatorcontrib><creatorcontrib>Mayr, Edgar</creatorcontrib><creatorcontrib>Förch, Stefan</creatorcontrib><title>Plain X-ray is insufficient for correct diagnosis of tibial shaft spiral fractures: a prospective trial</title><title>European journal of trauma and emergency surgery (Munich : 2007)</title><addtitle>Eur J Trauma Emerg Surg</addtitle><addtitle>Eur J Trauma Emerg Surg</addtitle><description>Purpose
Tibial shaft spiral fractures and fractures of the distal third of the tibia (AO:42A/B/C and 43A) frequently occur with non-displaced posterior malleolus fractures (PM). This study investigated the hypothesis that plain X-ray is not sufficient for a reliable diagnosis of associated non-displaced PM fractures in tibial shaft spiral fractures.
Methods
50 X-rays showing 42A/B/C and 43A fractures were evaluated by two groups of physicians, each group was comprised of a resident and a fellowship-trained traumatologist or radiologist. Each group was tasked to make a diagnosis and/or suggest if further imaging was needed. One group was primed with the incidence of PM fractures and asked to explicitly assess the PM.
Results
Overall, 9.13/25 (SD ± 5.77) PM fractures were diagnosed on X-ray. If the posterior malleolus fracture was named or a CT was requested, the fracture was considered “detected”. With this in mind, 14.8 ± 5.95 posterior malleolus fractures were detected.
Significantly more fractures were diagnosed/detected (14 vs. 4.25/25;
p
< 0.001/14.8 vs. 10.5/25;
p
< 0.001) in the group with awareness. However, there were significantly more false positives in the awareness group (2.5 vs. 0.5;
p
= 0.024). Senior physicians recognized slightly more fractures than residents (residents: 13.0 ± 7.79; senior physicians: 16.5 ± 3.70;
p
= 0.040). No significant differences were demonstrated between radiologists and trauma surgeons.
The inner-rater reliability was high with 91.2% agreement. Inter-rater reliability showed fair agreement (Fleiss-Kappa 0.274,
p
< 0.001) across all examiners and moderate agreement (Fleiss-Kappa 0.561,
p
< 0.001) in group 2.
Conclusion
Only 17% of PM fractures were identified on plain X-ray and awareness of PM only improved diagnosis by 39%. While experiencing improved accuracy, CT imaging should be included in a comprehensive examination of tibial shaft spiral fractures.
Level of evidence
II. Diagnostic prospective cohort study.
Trail registration number
DRKS00030075.</description><subject>Ankle Fractures - diagnostic imaging</subject><subject>Ankle Fractures - surgery</subject><subject>Critical Care Medicine</subject><subject>Emergency Medicine</subject><subject>Fractures</subject><subject>Hip joint</subject><subject>Humans</subject><subject>Intensive</subject><subject>Medical diagnosis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original</subject><subject>Original Article</subject><subject>Orthopedics</subject><subject>Prospective Studies</subject><subject>Reproducibility of Results</subject><subject>Retrospective Studies</subject><subject>Sports Medicine</subject><subject>Surgery</subject><subject>Surgical Orthopedics</subject><subject>Tibia</subject><subject>Tibial Fractures - surgery</subject><subject>Tomography, X-Ray Computed - methods</subject><subject>Traumatic Surgery</subject><subject>X-Rays</subject><issn>1863-9933</issn><issn>1863-9941</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNp9kUtPxCAUhYnR-Bj9Ay4MiRs3VR6Ftm6MMb4SE124cEcohRHTKRVao__eO46Oj4ULAuR-93AuB6FdSg4pIcVRIoTIMiOMw2KlyF5X0CYtJc-qKqeryzPnG2grpSegiRRsHW3wgsmKk3wTTe9a7Tv8kEX9hn3Cvkujc9542w3YhYhNiNGaATdeT7uQAAkOD772usXpUbsBp95HuLiozTBGm46xxn0MqYc2_2LxEIHdRmtOt8nufO4TdH9xfn92ld3cXl6fnd5kJi_EkBWWONOUDXN5OTdopChsY2tRMgGejXZGGqqdqBlnUlSkanjheGONqKku-QSdLGT7sZ7ZxsAU4E310c90fFNBe_W70vlHNQ0vipKClYxVoHDwqRDD82jToGY-Gdu2urNhTGpO8SLn8LUTtP8HfQpj7GA8xSrCKaFSEqDYgjLwJylat3RDiZrnqBY5KshRfeSoXqFp7-ccy5av4ADgCyBBqZva-P32P7LvFZ6rUA</recordid><startdate>20231201</startdate><enddate>20231201</enddate><creator>Lisitano, Leonard</creator><creator>Röttinger, Timon</creator><creator>Wiedl, Andreas</creator><creator>Rau, Kim</creator><creator>Helling, Sönke</creator><creator>Cifuentes, Jairo</creator><creator>Jehs, Bertram</creator><creator>Härting, Mark</creator><creator>Feitelson, Laura-Marie</creator><creator>Gleich, Johannes</creator><creator>Kiesl, Sophia</creator><creator>Pfeufer, Daniel</creator><creator>Neuerburg, Carl</creator><creator>Mayr, Edgar</creator><creator>Förch, Stefan</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-2194-4487</orcidid></search><sort><creationdate>20231201</creationdate><title>Plain X-ray is insufficient for correct diagnosis of tibial shaft spiral fractures: a prospective trial</title><author>Lisitano, Leonard ; Röttinger, Timon ; Wiedl, Andreas ; Rau, Kim ; Helling, Sönke ; Cifuentes, Jairo ; Jehs, Bertram ; Härting, Mark ; Feitelson, Laura-Marie ; Gleich, Johannes ; Kiesl, Sophia ; Pfeufer, Daniel ; Neuerburg, Carl ; Mayr, Edgar ; Förch, Stefan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c475t-7e0fcd8d2f489304c657edeb5825726cafc6c1af5b23265909d37f3dec5b1a83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Ankle Fractures - diagnostic imaging</topic><topic>Ankle Fractures - surgery</topic><topic>Critical Care Medicine</topic><topic>Emergency Medicine</topic><topic>Fractures</topic><topic>Hip joint</topic><topic>Humans</topic><topic>Intensive</topic><topic>Medical diagnosis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original</topic><topic>Original Article</topic><topic>Orthopedics</topic><topic>Prospective Studies</topic><topic>Reproducibility of Results</topic><topic>Retrospective Studies</topic><topic>Sports Medicine</topic><topic>Surgery</topic><topic>Surgical Orthopedics</topic><topic>Tibia</topic><topic>Tibial Fractures - surgery</topic><topic>Tomography, X-Ray Computed - methods</topic><topic>Traumatic Surgery</topic><topic>X-Rays</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lisitano, Leonard</creatorcontrib><creatorcontrib>Röttinger, Timon</creatorcontrib><creatorcontrib>Wiedl, Andreas</creatorcontrib><creatorcontrib>Rau, Kim</creatorcontrib><creatorcontrib>Helling, Sönke</creatorcontrib><creatorcontrib>Cifuentes, Jairo</creatorcontrib><creatorcontrib>Jehs, Bertram</creatorcontrib><creatorcontrib>Härting, Mark</creatorcontrib><creatorcontrib>Feitelson, Laura-Marie</creatorcontrib><creatorcontrib>Gleich, Johannes</creatorcontrib><creatorcontrib>Kiesl, Sophia</creatorcontrib><creatorcontrib>Pfeufer, Daniel</creatorcontrib><creatorcontrib>Neuerburg, Carl</creatorcontrib><creatorcontrib>Mayr, Edgar</creatorcontrib><creatorcontrib>Förch, Stefan</creatorcontrib><collection>SpringerOpen(OpenAccess)</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Nursing and Allied Health Source</collection><collection>ProQuest Health and Medical</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep (ProQuest)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest research library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>European journal of trauma and emergency surgery (Munich : 2007)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lisitano, Leonard</au><au>Röttinger, Timon</au><au>Wiedl, Andreas</au><au>Rau, Kim</au><au>Helling, Sönke</au><au>Cifuentes, Jairo</au><au>Jehs, Bertram</au><au>Härting, Mark</au><au>Feitelson, Laura-Marie</au><au>Gleich, Johannes</au><au>Kiesl, Sophia</au><au>Pfeufer, Daniel</au><au>Neuerburg, Carl</au><au>Mayr, Edgar</au><au>Förch, Stefan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Plain X-ray is insufficient for correct diagnosis of tibial shaft spiral fractures: a prospective trial</atitle><jtitle>European journal of trauma and emergency surgery (Munich : 2007)</jtitle><stitle>Eur J Trauma Emerg Surg</stitle><addtitle>Eur J Trauma Emerg Surg</addtitle><date>2023-12-01</date><risdate>2023</risdate><volume>49</volume><issue>6</issue><spage>2339</spage><epage>2345</epage><pages>2339-2345</pages><issn>1863-9933</issn><eissn>1863-9941</eissn><abstract>Purpose
Tibial shaft spiral fractures and fractures of the distal third of the tibia (AO:42A/B/C and 43A) frequently occur with non-displaced posterior malleolus fractures (PM). This study investigated the hypothesis that plain X-ray is not sufficient for a reliable diagnosis of associated non-displaced PM fractures in tibial shaft spiral fractures.
Methods
50 X-rays showing 42A/B/C and 43A fractures were evaluated by two groups of physicians, each group was comprised of a resident and a fellowship-trained traumatologist or radiologist. Each group was tasked to make a diagnosis and/or suggest if further imaging was needed. One group was primed with the incidence of PM fractures and asked to explicitly assess the PM.
Results
Overall, 9.13/25 (SD ± 5.77) PM fractures were diagnosed on X-ray. If the posterior malleolus fracture was named or a CT was requested, the fracture was considered “detected”. With this in mind, 14.8 ± 5.95 posterior malleolus fractures were detected.
Significantly more fractures were diagnosed/detected (14 vs. 4.25/25;
p
< 0.001/14.8 vs. 10.5/25;
p
< 0.001) in the group with awareness. However, there were significantly more false positives in the awareness group (2.5 vs. 0.5;
p
= 0.024). Senior physicians recognized slightly more fractures than residents (residents: 13.0 ± 7.79; senior physicians: 16.5 ± 3.70;
p
= 0.040). No significant differences were demonstrated between radiologists and trauma surgeons.
The inner-rater reliability was high with 91.2% agreement. Inter-rater reliability showed fair agreement (Fleiss-Kappa 0.274,
p
< 0.001) across all examiners and moderate agreement (Fleiss-Kappa 0.561,
p
< 0.001) in group 2.
Conclusion
Only 17% of PM fractures were identified on plain X-ray and awareness of PM only improved diagnosis by 39%. While experiencing improved accuracy, CT imaging should be included in a comprehensive examination of tibial shaft spiral fractures.
Level of evidence
II. Diagnostic prospective cohort study.
Trail registration number
DRKS00030075.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>37269304</pmid><doi>10.1007/s00068-023-02285-x</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-2194-4487</orcidid><oa>free_for_read</oa></addata></record> |
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identifier | ISSN: 1863-9933 |
ispartof | European journal of trauma and emergency surgery (Munich : 2007), 2023-12, Vol.49 (6), p.2339-2345 |
issn | 1863-9933 1863-9941 |
language | eng |
recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10728229 |
source | Springer Nature |
subjects | Ankle Fractures - diagnostic imaging Ankle Fractures - surgery Critical Care Medicine Emergency Medicine Fractures Hip joint Humans Intensive Medical diagnosis Medicine Medicine & Public Health Original Original Article Orthopedics Prospective Studies Reproducibility of Results Retrospective Studies Sports Medicine Surgery Surgical Orthopedics Tibia Tibial Fractures - surgery Tomography, X-Ray Computed - methods Traumatic Surgery X-Rays |
title | Plain X-ray is insufficient for correct diagnosis of tibial shaft spiral fractures: a prospective trial |
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