What Is the Interrater and Intrarater Reliability of the Lawrence and Botte Classification System of Fifth Metatarsal Base Fractures?. (Record no. 816)

MARC details
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fixed length control field 04893nam a22004217a 4500
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fixed length control field 220221s20222022 xxu||||| |||| 00| 0 eng d
024 ## - OTHER STANDARD IDENTIFIER
Standard number or code 00003086-990000000-00629 [pii]
024 ## - OTHER STANDARD IDENTIFIER
Standard number or code 10.1097/CORR.0000000000002131 [doi]
040 ## - CATALOGING SOURCE
Original cataloging agency Ovid MEDLINE(R)
099 ## - LOCAL FREE-TEXT CALL NUMBER (OCLC)
PMID 35081080
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Title What Is the Interrater and Intrarater Reliability of the Lawrence and Botte Classification System of Fifth Metatarsal Base Fractures?.
251 ## - Source
Source Clinical Orthopaedics & Related Research. 2022 Jan 26
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Abbreviated source Clin Orthop. 2022 Jan 26
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Journal name Clinical orthopaedics and related research
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Year 2022
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Manufacturer FY2022
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Publication date 2022 Jan 26
265 ## - SOURCE FOR ACQUISITION/SUBSCRIPTION ADDRESS [OBSOLETE]
Publication status aheadofprint
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Date added to catalog 2022-02-21
501 ## - WITH NOTE
Local holdings Available online from MWHC library: 1997 - present, Available in print through MWHC library: 1999 - 2003
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Abstract BACKGROUND: Fractures of the proximal fifth metatarsal are common, and often they are classified using a three-part scale first proposed by Lawrence and Botte. A clear consensus on prognosis and treatment for these fractures is lacking, particularly for fractures in the middle classification, Zone 2; the reliability of the classification scheme itself may be partly at fault for this. The intra- and interrater reliability of the classification itself has never been established, and it remains unclear whether the three-part classification of fifth metatarsal fractures can be applied consistently enough to guide treatment.
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Abstract CONCLUSION: The three-part Lawrence and Botte classification system demonstrated a concerningly low level of interrater reliability with an observed agreement of 77% compared with a chance agreement of 33%. The primary source of concern is the assessment of the interface between Zone 2 and Zone 3, which proved much less reliable than that between Zone 1 and Zone 2. This suggests that previous studies of isolated Zone 1 fractures likely contain a homogeneous fracture cohort, whereas studies of Zone 2 or Zone 3 fractures are likely to include a mixture of fracture types. In practice, the consensus treatment of fifth metatarsal fractures differs based on whether they represent a more proximal, avulsive injury or a more distal injury from indirect trauma. Our data suggest that the Lawrence and Botte classification should be abandoned. Further work should focus on developing a new classification scheme that demonstrates improved interobserver reliability and more directly corresponds to this treatment paradigm.
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Abstract LEVEL OF EVIDENCE: Level III, diagnostic study. Copyright (c) 2022 by the Association of Bone and Joint Surgeons.
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Abstract METHODS: Thirty sets of initial presentation radiographs representing an equal number of fractures originally diagnosed by treating clinicians as Zone 1, Zone 2, and Zone 3 were evaluated and classified by three orthopaedic surgeons specializing in foot and ankle surgery and eight foot and ankle fellows to determine interrater reliability. Two weeks later, the same set of radiographs were reevaluated in random order to determine intrarater reliability. Kappa values for interrater and intrarater reliability were calculated. Additionally, the individual transitions between zones were separately analyzed by calculating kappa values for a hypothetical two-part classification based on each transition.
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Abstract QUESTIONS/PURPOSES: When used by experienced orthopaedic surgeons, (1) What is the overall interrater reliability of the three-part Lawrence and Botte classification of fifth metatarsal base fractures? (2) What is the overall intrarater reliability of the three-part Lawrence and Botte classification of fifth metatarsal base fractures? (3) What are these same metrics for the individual transitions within the classification (Zone 1-2 and Zone 2-3)?
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Abstract RESULTS: The three-part Lawrence and Botte classification of fifth metatarsal fractures demonstrated an overall interrater agreement of kappa = 0.66 (observed agreement 77% versus chance agreement 33%). Intrarater reliability for the 11 surgeons ranged from kappa = 0.60 to kappa = 0.90. A two-part scheme divided by the transition between Zone 1 and Zone 2 demonstrated an interrater agreement of kappa = 0.83, and a two-part scheme divided by the transition between Zone 2 and Zone 3 demonstrated a much lower interrater reliability of kappa = 0.66.
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Language note English
650 ## - SUBJECT ADDED ENTRY--TOPICAL TERM
Topical term or geographic name entry element IN PROCESS -- NOT YET INDEXED
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Institution MedStar Union Memorial Hospital
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Department Orthopaedic Surgery
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Medline publication type Journal Article
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Local Authors Abousayed, Mostafa
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Local Authors Guyton, Gregory P
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Local Authors Noori, Naudereh
790 ## - Authors
All authors Abousayed M, Coleman MM, Guyton GP, Noori N
856 ## - ELECTRONIC LOCATION AND ACCESS
DOI <a href="https://dx.doi.org/10.1097/CORR.0000000000002131">https://dx.doi.org/10.1097/CORR.0000000000002131</a>
Public note https://dx.doi.org/10.1097/CORR.0000000000002131
942 ## - ADDED ENTRY ELEMENTS (KOHA)
Koha item type Journal Article
Item type description Article
Holdings
Withdrawn status Lost status Damaged status Not for loan Collection Home library Current library Date acquired Total Checkouts Full call number Barcode Date last seen Price effective from Koha item type
          MedStar Authors Catalog MedStar Authors Catalog 02/21/2022   35081080 35081080 02/21/2022 02/21/2022 Journal Article

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