Inter- And Intraobserver Reliability In The Assessment Of Glenoid Fracture Classifications.

Throughout literature a number of glenoid classification systems have been described but lack clear correlation with the fracture patterns found in clinical cases. This study aimed to evaluate the intra- and interobserver agreement for fracture classifications of the glenoid, using either plain radiographs, computed tomography (CT) scans. The study was retrospective, using images with a variety of fracture types. Six observers classified the fracture patterns. Classifications of Ideberg, OTAAO, Mayo and Euler/Ruedi were used. Agreement was determined using kappa coefficients. Currently used glenoid fracture classification systems have a fair to moderate intraobserver reliability. Combining plain radiographs and CT scans led to a better observer agreement. For interoberserver reliability, the system of Euler scored slightly better than other systems. Although Ideberg's classification is the most widely used system, this study does not support superiority of it. Based on this study there is need for a more reliable glenoid classification system.

The flying buttress construct for posterior spinopelvic fixation: a technical note.

BACKGROUND: Posterior fusion of the spine to the pelvis in paediatric and adult spinal deformity is still challenging. Especially assembling of the posterior rod construct to the iliac screw is considered technically difficult. A variety of spinopelvic fixation techniques have been developed. However, extreme bending of the longitudinal rods or the use of 90-degree lateral offset connectors proved to be difficult, because the angle between the rod and the iliac screw varies from patient to patient. METHODS: We adopted a new spinopelvic fixation system, in which iliac screws are side-to-side connected to the posterior thoracolumbar rod construct, independent of the angle between the rod and the iliac screw. Open angled parallel connectors are used to connect short iliac rods from the posterior rod construct to the iliac screws at both sides. The construct resembles in form and function an architectural Flying Buttress, or lateral support arches, used in Gothic cathedrals. RESULTS AND DISCUSSION: Three different cases that illustrate the Flying Buttress construct for spinopelvic fixation are reported here with the clinical details, radiographic findings and surgical technique used. CONCLUSION: The Flying Buttress construct may offer an alternative surgical option for spinopelvic fixation in circumstances wherein coronal or sagittal balance cannot be achieved, for example in cases with significant residual pelvic obliquity, or in revision spinal surgery for failed lumbosacral fusion.