External skeletal fixation is a treatment modality commonly used in veterinary orthopedic surgery for orthopedic ailments including fractures, angular limb deformities, and joint instability. Soft tissue inflammation at the ISI is common, particularly when ESF is maintained for > 8 weeks, with incidence approaching 100% in veterinary medicine1 and ranging from 50% to 96% in human medicine.2–7 Many authors consider this inflammation to be a minor complication; however, in human medicine, it can sometimes lead to pain, lameness, septic osteoarthritis, and chronic osteomyelitis threatening the stability of the implant-bone interface.7–9 Changes at the ISI likely cause similar outcomes in dogs as in humans. In veterinary medicine, drainage after ESF is particularly common in the proximal aspect of the antebrachium and crus, compared with results after ESF in the middle and distal aspects of the antebrachium and crus.10,11
Although complications associated with ISI inflammation during ESF are described in human2–4,7–9,12 and veterinary1,13–16 medicine, validated scoring systems that describe the condition of that interface are lacking. Development of a validated scoring system for inflammation at the ISI is an essential step to enable clinicians to reach evidence-based conclusions about outcomes and complications in clinical studies involving ESF. Without such a validated scoring system, conclusions based on defensible assessment of the ISI, and therefore treatments aimed at reducing inflammation at the ISI, cannot be made. Objectives of the study reported here were to develop an inflammation scoring system for the ISI, evaluate intraobserver repeatability and interobserver agreement of ISI inflammation scores, and evaluate in vivo and photographic agreement of ISI inflammation scores. We hypothesized that ISI inflammation scores would have high intraobserver repeatability and high interobserver agreement (Cronbach α > 0.7).17 We also hypothesized that ISI scores would have high agreement (Cronbach α > 0.7) when in vivo and photographic scores were compared.
The authors thank Dr. Robert Radasch for assistance with recruitment of cases.
External skeletal fixation
Intraclass correlation coefficient
Pocket color wheel, The Color Wheel Co, Philomath, Ore.
Adobe Photoshop, version 14.1.2, Adobe Systems Inc, San Jose, Calif.
Shutterfly, Redwood City, Calif.
Canon PowerShot ELPH 320 HS, Canon USA, Melville, NY.
SAS, version 9.4, SAS Institute Inc, Cary, NC.
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