%0 Journal Article
%T Preventing surgical complications: A survey on surgeons' perception of intra-articular malleolar screw misplacement in a cadaveric study
%A Vincenzo Giordano
%A Arthur FS Gomes
%A Ney P Amaral
%A Rodrigo P Albuquerque
%A Robinson ES Pires
%J Patient Safety in Surgery
%D 2011
%I BioMed Central
%R 10.1186/1754-9493-5-24
%X Nine preserved human cadaveric lower extremity specimens were used. Under direct visualization, two 4.0 mm cancellous screws were inserted into the medial malleolus. Each specimen was analyzed radiographically using antero-posterior (AP) and mortise views. The X-rays were randomly uploaded on a CD-ROM and included in a survey submitted to ten selected orthopaedic surgeons. The "Standards for Reporting of Diagnostic Accuracy" (STARD) questionnaire was used to determine the surgeons' perception of accuracy of screw placement in the medial malleolus. The selection of items was based on evidence whenever possible, therefore the "inconclusive" category was added. Inter and intraobserver variations were analyzed by kappa statistics to measure the amount of agreement.There was a poor level of agreement (kappa 0.4) both in the AP and in the mortise view among all the examiners. Associating the two x-rays, the agreement remained poor (kappa 0.4). In the cases in which there was a diagnosis of articular penetration, there was a poor agreement related to which of the screws was intra-articular. The number of "inconclusive" responses was low and constant, without a statistically significant difference between the subspecialistsThe routine intraoperative radiographic imaging of the ankle is difficult to interpret and unreliable for detection of intra-articular hardware penetration. We therefore recommend to reposition medial malleolar screws intraoperatively if there is any doubt regarding inadequate screw placement.Transverse fractures of the medial malleolus present in several different patterns affecting all ages. The importance of anatomic reduction and rigid internal fixation in displaced fractures of the medial malleolus has been emphasized in order to achieve rapid return of normal function and to reduce the incidence of complications related to this fracture [1]. Stable fixation can be accomplished either by lag screws or K-wires with or without cerclage wiring [2-6]. Th
%K Ankle
%K Fracture
%K Cadaver
%K STARD
%U http://www.pssjournal.com/content/5/1/24