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European Journal of Trauma and Emergency Surgery

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Open Access 01-02-2022 | CT Angiography | Original Article

Interobserver reliability of the Gehweiler classification and treatment strategies of isolated atlas fractures: an internet-based multicenter survey among spine surgeons

Authors: Markus Laubach, Miguel Pishnamaz, Matti Scholz, Ulrich Spiegl, Richard Martin Sellei, Christian Herren, Frank Hildebrand, Philipp Kobbe

Published in: European Journal of Trauma and Emergency Surgery | Issue 1/2022

Abstract

Purpose

Atlas (C1) fractures are commonly rated according to the Gehweiler classification, but literature on its reliability is scarce. In addition, evaluation of fracture stability and choosing the most appropriate treatment regime for C1-injuries are challenging. This study aimed to investigate the interobserver reliability of the Gehweiler classification and to identify whether evaluation of fracture stability as well as the treatment of C1-fractures are consistent among spine surgeons.

Methods

Computed tomography images of 34 C1-fractures and case-specific information were presented to six experienced spine surgeons. C1-fractures were graded according to the Gehweiler classification, and the suggested treatment regime was recorded in a questionnaire. For data analyses, SPSS was used, and interobserver reliability was calculated using Fleiss’ kappa (κ) statistics.

Results

We observed a moderate reliability for the Gehweiler classification (κ = 0.50), the evaluation of fracture stability (κ = 0.50), and whether a surgical or non-surgical therapy was indicated (κ = 0.53). Type 1, 2, 3a, and 5 fractures were rated stable and treated non-surgically. Type 3b fractures were rated unstable in 86.7% of cases and treated by surgery in 90% of cases. Atlas osteosynthesis was most frequently recommended (65.4%). Overall, 25.8% of type 4 fractures were rated unstable, and surgery was favoured in 25.8%.

Conclusion

We found a moderate reliability for the Gehweiler classification and for the evaluation of fracture stability. In particular, diverging treatment strategies for type 3b fractures emphasise the necessity of further clinical and biomechanical investigations to determine the optimal treatment of unstable C1-fractures.

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Title: Interobserver reliability of the Gehweiler classification and treatment strategies of isolated atlas fractures: an internet-based multicenter survey among spine surgeons
Authors: Markus Laubach
Miguel Pishnamaz
Matti Scholz
Ulrich Spiegl
Richard Martin Sellei
Christian Herren
Frank Hildebrand
Philipp Kobbe
Publication date: 01-02-2022
Publisher: Springer Berlin Heidelberg
Keyword: CT Angiography
Published in: European Journal of Trauma and Emergency Surgery / Issue 1/2022
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-020-01494-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Interobserver reliability of the Gehweiler classification and treatment strategies of isolated atlas fractures: an internet-based multicenter survey among spine surgeons

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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