Accessory Ossicles in the Region of the Foot and Ankle: An Epidemiologic Survey in a Jordanian Population
, Omar Alajoulin 2, Jamil Shawaqfeh 3, Ayman Mustafa 4,5, Shehab Jaber 6, Shaima’ Zaben 6, Ja’far Zapen 6 and Mohammad Alsalem 1Round 1
Reviewer 1 Report
Kalbouneh et al. Investigate the incidence of accessory bones in feet by investigating radiographs of 1000 patients from Jordan. The patients were referred to an emergency department, where the radiographs were taken. The latter were retrospectively evaluated by two expert radiologists, who assessed the data independent of each other. As accessory bones could be mistaken as avulsion fractures, this work sheds light on the surprisingly high incidence of these variations and might therefore help to avoid diagnostic errors.
The data were statistically evaluated using standard procedures, the interrater reliability is good. The most astonishing result is, at least in my opinion, the occurrence of additional ossicles in 40% of the radiographs. One could discuss, if the set radiographs from an emergency department is in fact representative of the general population. This question is difficult to address, however, since it would require to take radiographs from healthy volunteers which represent the general population.
In summary, the study is sound, the statistical methods employed are solid, the findings are concise and well presented. The findings are of potential clinical relevance, because they may help to avoid diagnostic errors. In order to make their argument concerning the frequency of additional ossicles stronger, a survey in healthy volunteers in a population would be required. Based on these consideration, I recommend the manuscript for publication in medicina without any changes.
Reviewer 2 Report
This retrospective study that planned to determine how frequently accessory ossicles were misdiagnosed as avulsion fractures is important for clinicians. The study was well planned and organized by the researchers.
