The use of plain radiographs in the classification of distal radius fractures

Objective: Diagnosis of a distal end radius fracture relies on various imaging studies. However, the relative usefulness of these studies is still a matter of some controversy. The aim of this study was to compare the intra-observer and inter-observer reliability of plain radiographs, standard computed tomography (CT) scans and mobile CT scans in the assessment of distal radius fractures as categorized by the Fernandez classification method. The secondary objective was to compare the dosages of radiation between the different imaging modalities. Material and Methods: Sixteen fresh cadaveric wrist bones were used in this experimental study. The desired fractures were created in the bones to mimic Fernandez types I-V fractures and plain radiographs were taken in 4 views. Standard CT and mobile CT scans were also taken with the fractured bones in the same four positions. Interobserver reliability was assessed using Kappa statistics to determine the diagnostic consistency among the nine observers. Inter-observer agreement was assessed based on the Fernandez classification system diagnoses. Results: Overall, the inter-observer agreement was substantial for the Fernandez classifications (Kappa range 0.636 0.727) in all types of imaging. For intra-observer agreement, the analysis found higher agreement for both standard CT scans and mobile CT scans. The standard CT images imparted a higher average dose of radiation than both the mobile CT scans and the plain radiographs.Conclusion: The mobile CT scan can provide an alternative imaging method for precise diagnosis of distal end radius fractures, with the additional benefits of mobility and lower radiation exposure.

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Interobserver Agreement and Intraobserver Reproducibility of Barzullah Working Classification of Distal End Radius Fractures among Orthopaedic Residents

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835516500028 ◽

2016 ◽

Vol 21 (01) ◽

pp. 24-29 ◽

Cited By ~ 1

Author(s):

Younis Kamal ◽

Hayat Ahmad Khan ◽

Naseem UI Gani ◽

Munir Farooq ◽

Adil Bashir Shah ◽

...

Keyword(s):

Distal Radius ◽

Interobserver Agreement ◽

Distal Radius Fractures ◽

Substantial Agreement ◽

Radius Fractures ◽

Intraobserver Reproducibility ◽

Moderate Agreement ◽

Kappa Value ◽

The Mean

Background: The purpose of this study is to test the hypothesis of the new classification system of distal end radius fractures (Barzullah working classification) proposed by one of the author in a prospective cohort study, among the orthopaedic residents. Methods: The initial post-injury radiographs of 300 patients with distal radius fractures in a tertiary centre were classified by two junior residents (JR1 and JR2) and two senior residents (SR1 and SR2) in the emergency department over a period of two years. The collected data was analysed statistically by using Cohan's kappa for measuring Intraobserver reproducibility and Fleiss kappa for measuring Interobserver agreement. Results: The mean kappa value for Interobserver agreement was 0.53 (moderate agreement) at the end of one year and the mean kappa value at the end of study period was 0.64 (substantial agreement). The mean kappa value for Intraobserver reproducibility of JR1 was 0.45 (moderate agreement), JR2 was 0.39 (fair agreement), SR1 was 0.62 (substantial agreement) and SR2 was 0.67 (substantial agreement). Conclusions: Barzullah working classification of distal radius fractures presented in this study has good characteristics compared to those of already studied classification systems among orthopaedic residents.

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Classification of distal radius fractures

Acta Orthopaedica Scandinavica ◽

10.3109/17453678508993006 ◽

1985 ◽

Vol 56 (3) ◽

pp. 249-252 ◽

Cited By ~ 56

Author(s):

Soren Solgaard

Keyword(s):

Distal Radius ◽

Distal Radius Fractures ◽

Radius Fractures

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Patient–accident–fracture (PAF) classification of acute distal radius fractures in adults

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-018-2225-8 ◽

2018 ◽

Vol 28 (8) ◽

pp. 1459-1463 ◽

Cited By ~ 1

Author(s):

G. Herzberg ◽

T. Galissard ◽

M. Burnier

Keyword(s):

Distal Radius ◽

Distal Radius Fractures ◽

Radius Fractures

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Dorsal Cortical Breaks in Volar Barton Distal Radius Fractures

Hand ◽

10.1177/1558944719862644 ◽

2019 ◽

pp. 155894471986264

Author(s):

Michael C. Daly ◽

Taylor A. Horst ◽

Chaitanya S. Mudgal

Keyword(s):

Distal Radius ◽

Null Hypothesis ◽

Independent Predictor ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Fracture Geometry ◽

Plain Radiographs ◽

Fracture Patterns ◽

Discrete Fracture ◽

Surgical Fixation

Background: Volar Barton fractures involve the volar articular margin of the distal radius with proximal and volar subluxation of the carpus. Although traditionally conceptualized as partial articular, some volar Barton fractures are complete articular injuries due to a dorsal cortical break in the distal radial metaphysis. While dorsal cortical breaks can affect surgical strategy, they may be difficult to identify on plain radiographs and their epidemiology remains poorly characterized. Some authors have hypothesized an association with osteoporosis; however, this hypothesis remains untested. To better characterize volar Barton fractures, we analyzed fracture geometry on pre-operative computed tomography (CT) scans to: (1) determine the frequency of a dorsal cortical break; and (2) test the null hypothesis that a dorsal cortical break is not associated with age or gender. Methods: We retrospectively reviewed adults with a volar Barton distal radius fracture and an available pre-operative CT who underwent surgical fixation. Using multivariable logistic regression, we assessed whether age or gender was an independent predictor of a dorsal cortical break. Results: Forty patients (mean age 52 years, 57% female) were identified. Including the shaft as a fragment, 32 (80%) had 3 or more discrete fracture fragments. Thirty patients (75%) had a dorsal cortical break. Dorsal cortical breaks were not associated with either age or gender ( P > 0.05). Conclusions: Most (75%) patients with volar Barton distal radius fractures had a dorsal cortical break. Dorsal cortical breaks were not statistically associated with age or gender, suggesting these fracture patterns may not be associated with osteoporosis as previously hypothesized.

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