Results
fracture, fractures
SENSITIVITY
Overall, an average of 9.13 ± 5.77 of the 25 (36.5%) posterior malleolus fractures were correctly diagnosed. In group 1 (no awareness) 4.25 ± 3.77, in group 2 (increased awareness) 14 ± 0 were diagnosed. This was statistically significant (Sensitivity for detecting additional PM fractures in plain X-rays was 0.17 in group 1 and 0.56 in group 2 with a specificity of 0.98 (group 1) and 0.90 (group 2; overall sensitivity 0.365, specificity 0.94) (see Table Summary of PM fractures diagnosed in plain X-rays“Diagnosed PM fractures” refers to the 25 patients with addition PM fracture in the CT imaging. “False positive” refers to the 25 patients without a PM fractur in the CT imaging. **Indicates highly significant values. *Indicates significant valuesPreoperative detection of additional fractures of the posterior malleolus is clinically relevant. In the following, a fracture of the posterior malleolus was considered "detected" if it was either diagnosed by plain X-ray or a CT showing the ankle joint was requested based on the available X-ray (or both). Due to the high sensitivity of CT imaging, it was assumed that all additional fractures of the PM would have been detected on CT.Considering this, an average of 14.8 ± 5.95 of 25 posterior malleolus fractures were detected. Statistically significantly more additional PM fractures were detected in group 2 (increased awareness) (10.5 ± 5.80 in group 1 vs. 19.0 ± 0.82 in group 2; Summary of the additional PM fractures that would have been detected before surgery (diagnosed fractures in plain X-ray or (/and) for diagnostic purpose requested CT imaging showing the ankle joint based on the plain X-ray)**Indicates highly significant valuesSenior physicians recognized slightly more accompanying PM fractures than residents (residents: 13.0 ± 7.79; senior physicians 16.5 ± 3.70; Summary of the additional PM fractures that would have been detected before surgery divided by level of training and specialty* indicates significant valuesTable Overview of patients (#1–25; first column) with additional fractures of the posterior malleolusThe last column indicates whether the fracture of the posterior malleolus was surgically stabilized (screw fixation; Y = Yes; N = No). The remaining columns show the individual physicians results in the first survey. Y = posterior malleolus fracture detected, i.e. the fracture was described or CT imaging showing the ankle was requested. N = the fracture was not named and no CT imaging was requested. R-X-X = resident; S-X-X = senior physician; X-S-X = surgery; X-R-X = radiology; X-X-1 = group 1; X-X-2 = group 2The inner-rater-reliability (the same examiner assesses the same X-ray images a second time) for detection of an additional fracture in group 2 from the first to the second assessment showed a high absolute agreement of 91.2% in average (max. 100%, min. 76%). Cohen’s kappa was calculated for all examiners and showed “moderate” to “almost perfect” agreement (0.534–0.907; The inter-rater-reliability for all physicians (8 examiners) for the first review indicated “fair” agreement for diagnosed (Fleiss’ kappa = 0.292, Divided into groups, group 1 (no previous knowledge) showed a fair agreement (Fleiss’ kappa = 0.234, 