External Validation of the Radiographic Investigation of the Distal Extension of Fractures Into the Articular Surface of the Tibia (RIDEFAST Study)

Ajinkya Rane, Lance Glen Jacobson, Patrick Kellam, Lucas Scott Marchand, Zachary M. Working, Jerrod A. Steimle, Thomas F. Higgins, David Lynn Rothberg, Timothy G. Weber, Justin Haller

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE: To test the external validity of the fracture to plafond (FTP-length of fracture/distance to plafond) ratio to rule out distal intra-articular fractures (DIA) in distal tibial shaft fractures at an independent tertiary trauma center. DESIGN: Retrospective cohort study. SETTING: Two Level 1 trauma centers. PATIENTS: Two hundred seventeen patients with a distal tibial shaft fracture in the model cohort and 146 patients in the validation cohort. INTERVENTION: Radiographic measurements to calculate FTP ratio. MAIN OUTCOME MEASUREMENTS: Calibration plots, area under receiver operating characteristic curve (AUC), and decision curve analyses to evaluate the external validity of FTP ratio to determine DIA. RESULTS: The AUC for the anteroposterior (AP) FTP ratio was 0.83 [95% confidence interval (CI) 0.78-0.88] in the model data set and 0.86 (95% CI 0.80-0.91) in the validation data set. The AUC for the lateral FTP ratio was 0.82 (95% CI 0.77-0.87) in the model data set and 0.82 (95% CI 0.75-0.88) in the validation data set. The previously established AP FTP cutoff ratio of 0.61 had a 94% negative predictive value in the model cohort and a 100% negative predictive value in the validation cohort. CONCLUSION: The FTP ratio is an effective and externally validated screening tool to rule out DIA in distal tibia shaft fractures. LEVEL OF EVIDENCE: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Original languageEnglish (US)
Pages (from-to)479-484
Number of pages6
JournalJournal of orthopaedic trauma
Volume35
Issue number9
DOIs
StatePublished - Sep 1 2021

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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