DOS 2016

DOS Kongressen 2016 ·

Can trauma surgeon’s subjective intraoperative

conclusions on patients bone quality be trusted?

Ole Brink, Tei Randi, Langdahl Bente

Orthopaedic Surgery - Traumatology, Aarhus University Hospital ; Department

of Endocrinology and Internal Medicine , Aarhus University Hospital ; Department

of Endocrinology and Internal Medicine , Aarhus University Hospital

Background:

How are my bones, do I have osteoporosis? Orthopedic surgeons

are occasionally asked this question, but how valid is the surgeons answer?

Purpose / Aim of Study:

The purpose of this study was to validate trauma

surgeon’s estimation of bone quality and conclusions whether a patient under-

going fracture surgery has osteoporosis or not.

Materials and Methods:

Trauma surgeons were asked to evaluate the quality

of the bone on a 10 cm visual analogue scale (VAS) ranging from very poor to

extremely high bone quality. The surgeons also concluded “osteoporosis”, “not

osteoporosis” or “not able to answer”. Within three months after surgery all

patients were invited to a dual x-ray absorptiometry (DXA) for measuring bone

mineral density. ROC curves were used as diagnostic tools to describe the accu-

racy of VAS score against DXA. Nonparametric methods were used to calculate

area under the ROC curves.

Findings / Results:

Fifty-three patients were included. Area under the ROC

curve measuring accuracy of VAS as diagnostics tool for osteoporosis was 0.698

and for diagnosing a status of osteopenia or osteoporosis the area was 0.727.

Using a cut point on the VAS scale 4 cm or less as diagnostics for osteoporosis

the sensitivity was 84%, the specificity 42% and 75% were correctly classified.

Using the same cut point of 4 cm for diagnosing osteopenia or osteoporosis

from the VAS scale the sensitivity was 93%, specificity 27% and 45% were

correctly classified. The positive predictive value of the surgeons’ conclusion

of osteoporosis was 50% and the negative predictive value was 83%. If sur-

geons’ conclusion of osteoporosis was used as a surrogate for any abnormal low

bone density (osteopenia or osteoporosis) the positive predictive value raised

to 86%.

Conclusions:

The trauma surgeon’s conclusions concerning a patients bone

quality can be trusted to some degree.

No conflicts of interest reported

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