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Erschienen in:

22.07.2024 | Original Article

The ballistic articular structure injury classification (BASIC) system: clarifying ballistic articular injuries

verfasst von: Daniel Portney, Hayden Baker, Sarthak Aggarwal, Douglas Dirschl, Daryl Dillman, Jason Strelzow

Erschienen in: European Journal of Orthopaedic Surgery & Traumatology | Ausgabe 6/2024

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Abstract

Purpose

This study aims to (1) devise a classification system to categorize and manage ballistic fractures of the knee, hip, and shoulder; (2) assess the reliability of this classification compared to current classification schemas; and (3) determine the association of this classification with surgical management.

Methods

We performed a retrospective review of a prospectively collected trauma database at an urban level 1 trauma centre. The study included 147 patients with 169 articular fractures caused by ballistic trauma to the knee, hip, and shoulder. Injuries were selected based on radiographic criteria from plain radiographs and CT scans. The AO/OTA classification system’s reliability was compared to that of the novel ballistic articular injury classification system (BASIC), developed using a nominal group approach. The BASIC system’s ability to guide surgical decision-making, aiming to achieve stable fixation and minimize post-traumatic arthritis, was also evaluated.

Results

The BASIC system was created after analysing 73 knee, 62 hip, and 34 shoulder fractures. CT scans were used in 88% of cases, with 44% of patients receiving surgery. The BASIC classification comprises five subgroups, with a plus sign indicating the need for soft tissue intervention. Interrater reliability showed fair agreement for AO/OTA (k = 0.373) and moderate agreement for BASIC (k = 0.444). The BASIC system correlated strongly with surgical decisions, with an 83% concurrence in treatment choices based on chart reviews.

Conclusions

Conventional classification systems provide limited guidance for ballistic articular injuries. The BASIC system offers a pragmatic and reproducible alternative, with potential to inform treatment decisions for knee, hip, and shoulder ballistic injuries. Further research is needed to validate this system and its correlation with patient outcomes.

Level of evidence

Level III, Diagnostic Study.
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Metadaten
Titel
The ballistic articular structure injury classification (BASIC) system: clarifying ballistic articular injuries
verfasst von
Daniel Portney
Hayden Baker
Sarthak Aggarwal
Douglas Dirschl
Daryl Dillman
Jason Strelzow
Publikationsdatum
22.07.2024
Verlag
Springer Paris
Erschienen in
European Journal of Orthopaedic Surgery & Traumatology / Ausgabe 6/2024
Print ISSN: 1633-8065
Elektronische ISSN: 1432-1068
DOI
https://doi.org/10.1007/s00590-024-04049-8

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