scholarly journals Artificial intelligence to diagnosis distal radius fracture using biplane plain X-rays

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Kunihiro Oka ◽  
Ryoya Shiode ◽  
Yuichi Yoshii ◽  
Hiroyuki Tanaka ◽  
Toru Iwahashi ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Diagnostic Accuracy ◽  
Distal Radius ◽  
Diagnostic Tests ◽  
Styloid Process ◽  
Final Diagnosis ◽  
Distal Radius Fractures ◽  
X Rays ◽  
Radius Fractures ◽  
X Ray

Abstract Background Although the automatic diagnosis of fractures using artificial intelligence (AI) has recently been reported to be more accurate than those by orthopedics specialists, big data with at least 1000 images or more are required for deep learning of the convolutional neural network (CNN) to improve diagnostic accuracy. The aim of this study was to develop an AI system capable of diagnosing distal radius fractures with high accuracy even when learning with relatively small data by learning to use bi-planar X-rays images. Methods VGG16, a learned image recognition model, was used as the CNN. It was modified into a network with two output layers to identify the fractures in plain X-ray images. We augmented 369 plain X-ray anteroposterior images and 360 lateral images of distal radius fractures, as well as 129 anteroposterior images and 125 lateral images of normal wrists to conduct training and diagnostic tests. Similarly, diagnostic tests for fractures of the styloid process of the ulna were conducted using 189 plain X-ray anteroposterior images of fractures and 302 images of the normal styloid process. The distal radius fracture is determined by entering an anteroposterior image of the wrist for testing into the trained AI. If it identifies a fracture, it is diagnosed as the same. However, if the anteroposterior image is determined as normal, the lateral image of the same patient is entered. If a fracture is identified, the final diagnosis is fracture; if the lateral image is identified as normal, the final diagnosis is normal. Results The diagnostic accuracy of distal radius fractures and fractures of the styloid process of the ulna were 98.0 ± 1.6% and 91.1 ± 2.5%, respectively. The areas under the receiver operating characteristic curve were 0.991 {n = 540; 95% confidence interval (CI), 0.984–0.999} and 0.956 (n = 450; 95% CI 0.938–0.973). Conclusions Our method resulted in a good diagnostic rate, even when using a relatively small amount of data.

scholarly journals P041: Accuracy of medical student-performed point-of-care ultrasound in the diagnosis of distal radius fractures in adults

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S92-S92
Author(s):  
L. Farnell ◽  
A.K. Hall ◽  
C. McKaigney
Keyword(s):  
Medical Students ◽  
Diagnostic Accuracy ◽  
Distal Radius ◽  
Point Of Care ◽  
Distal Radius Fractures ◽  
Point Of Care Ultrasound ◽  
Radiographic Imaging ◽  
Radius Fractures ◽  
Wide Range ◽  
Test Probability

Introduction: Previous investigations of the diagnostic accuracy of point-of-care ultrasound (POCUS) in distal radius fractures (DRF) report a wide range of sensitivities (71%-98%) and specificities (73%-100%) when performed by medical professionals, which may reflect inconsistencies in POCUS training or sonographer experience. The purpose of this study was to determine the accuracy of POCUS performed by pre-clerkship medical students with minimal POCUS training compared to standard radiography in diagnosing DRF in adult patients with traumatic wrist injuries, in order to assess POCUS as an alternative to traditional radiographic imaging. Methods: This prospective observational study was conducted from June to September 2015. The study population consisted of adults presenting to the emergency department (ED) with distal forearm pain secondary to traumatic injury within the past seven days and for whom radiographic imaging was ordered. Patients were evaluated using POCUS performed by medical students with no prior experience who had received one hour of POCUS training taught by an emergency ultrasound fellowship-trained ED physician. A pre-test probability of fracture was stratified as low or high and documented independently by the treating physician. Students were blinded to pre-test probability and radiography results. Results: Of the 52 patients enrolled, 18 had DRF diagnosed by radiographic imaging. Compared to radiography, student-performed POCUS had 72% overall sensitivity (95% CI, 47%-90%) and 85% specificity (95% CI, 69%-95%), with 81% overall accuracy. In the high pre-test probability group (N = 20), POCUS had 80% sensitivity (95% CI, 52%-96%) and 60% specificity (95% CI, 15%-95%). In the low pre-test probability group (N = 32), POCUS had 33% sensitivity (95% CI, 1%-91%) and 90% specificity (95% CI, 73%-98%). Conclusion: POCUS performed by medical students demonstrated reasonable success in diagnosing DRF, with overall sensitivity and specificity in keeping with published data. Within the low pre-test probability group, the diagnostic accuracy of POCUS suggests that ultrasound was an unreliable alternative to radiographic imaging for DRF in this cohort. Future analysis of the factors leading to DRF missed by POCUS as being related to adequacy of POCUS training, image capture, or sonographer experience will further explore the utility of POCUS as a diagnostic alternative.

scholarly journals The treatment of distal radius fractures accompanying dorsally displaced free fragments beyond the watershed line with turning radius and distal volaris radius system plate fixation via the distal palmar approach

2020 ◽  
Author(s):  
Zhaofeng Jia ◽  
Shijin Wang ◽  
Wei Jiang ◽  
Chuangli Li ◽  
Jiandong Lin ◽  
...  
Keyword(s):  
Distal Radius ◽  
Plate Fixation ◽  
Postoperative Recovery ◽  
Distal Radius Fractures ◽  
Therapeutic Effects ◽  
Dash Score ◽  
Radius Fractures ◽  
X Ray ◽  
Palmar Approach

Abstract Background: Although distal radius fractures (DRFs) are clinically common, DRFs accompanied by dorsally displaced free fragments beyond the watershed line are much less so. At present, it is very difficult to fix and stabilize the displaced free fragments far away from the watershed line with a plate. Our aim was to investigate the clinical effect of DRFs with distally displaced dorsal free mass treated with distal volaris radius (DVR) combined with turning of the radius via the distal palmar approach. Methods: From 2015 to 2019, 25 patients with distal radius fractures associated with dorsally displaced free fragments beyond the watershed line were selected and treated with distal volaris radius (DVR) combined with turning of the radius via the distal palmar approach. This study involved 14 males and 11 females, with an average age of 34.5 years (ranging from 21 to 50 years). The mean follow-up period was 16.5 months (ranging from 12 to 22 months). The dorsal displacement of the free fragments was analyzed by X-ray and three-dimensional computed tomography, allowing characterization of postoperative recovery effects by radial height, volar tilt and radial inclination. For the follow-up, we evaluated effects of the surgery by analyzing range of motion (ROM); Modified Mayo Wrist Score (MMWS); and Disabilities of Arm, Shoulder and Hand (DASH) score. Postoperative wound recovery and complications were also monitored to evaluate the clinical therapeutic effects of the surgical procedures. Results: X-ray showed that all patients showed reduced fractures, well-healed wounds and recovered function with no obvious complications. Based on the follow-up, patients had a mean radial height of 10.5mm (ranging from 8.1 to 12.6 mm), mean MMWS of 78.8° (ranging from 61 to 90°), mean DASH score of 16.25 (ranging from 11 to 21), mean ROM for volar flexion of 76.5° (ranging from 62 to 81°), mean ROM for dorsiflexion of 77.1° (ranging from 59 to 83) and mean VAS score of 1.4 (ranging from 1 to 3). Conclusion: Treatment of distal radius fractures with accompanying dorsally displaced free fragments beyond the watershed line with turning of the radius and the DVR plate system via the distal palmar approach is effective and has no obvious complications.

scholarly journals Results of the treatment of distal radius fractures with a proprietary implant, the DRONes nail plate – preliminary report

2020 ◽  
Vol 86 (2) ◽  
pp. 66-72
Author(s):  
Maciej Piotrowski ◽  
Keyword(s):  
Distal Radius ◽  
Soft Tissues ◽  
Full Range ◽  
Nail Plate ◽  
Functional Results ◽  
Distal Radius Fractures ◽  
Intramedullary Fixation ◽  
X Rays ◽  
Radius Fractures ◽  
Additional Advantage

Introduction. Distal radius fractures are one of the most common bone injuries. Modern treatment methods are needed not only to reduce the time needed to heal, but also allow the wrist the full range of motion as soon as possible. The solution should provide stable bone fixation with the least possible damage to soft tissues, which will allow quick recovery of extremity function. The method meeting these criteria is intramedullary fixation. Aim of the study. To evaluate the treatment results of distal radius fractures with the DRONes® hybrid nail plate. Material and methods. The study group consists of patients with distal radius fracture treated with open reduction and intramedullary fixation. Patients aged 24 to 69 years (average 54 years) were operated on after a failed attempt to adjust the fracture using the closed reduction method. 40 distal fractures of the distal radius qualified for the following 5 types according to AO: 2 fractures -A2, 5 -A3, 8 -C1, 14 -C2, 11 -C3. Two weeks after the surgery, X-rays were performed to check the position of the bone fragments and implant. After a further 6-7 weeks, the union and wrist function were evaluated. Results. Bone union was achieved in all patients within 8-9 weeks, and the range of wrist mobility was only slightly limited. The most common complication was the neurapraxia of the superficial branch of the radial nerve disappearing after 6-8 weeks. Conclusions. Patients treated with the DRONes® hybrid nail plate achieve good functional results after 8-9 weeks and can return to work and their preinjury lifestyle. An additional advantage is the simple surgical technique.

Radiographic Outcomes and Complications of Delayed Fixation of Distal Radius Fractures

Hand ◽  
2020 ◽  
pp. 155894472093030
Author(s):  
Stella J. Lee ◽  
Derek S. Stenquist ◽  
Jamie E. Collins ◽  
Ariana N. Mora ◽  
Brett A. Teplitz ◽  
...  
Keyword(s):  
Cohort Study ◽  
Surgical Treatment ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
X Rays ◽  
Matched Cohort ◽  
Radius Fractures ◽  
Radiographic Outcomes ◽  
Radiographic Parameters ◽  
Surgical Fixation

Background: Surgeons are sometimes presented with patients with distal radius fractures who present in a delayed fashion or lose reduction after several weeks of attempted closed management. There are limited studies on delayed surgical treatment of distal radius fractures to assist providers in decision-making. Methods: We conducted a matched cohort study to compare radiographic outcomes and complications for patients with a distal radius fracture treated with delayed (3-5 weeks) or early (0-2 weeks) surgical fixation. Patients ages 18+ who underwent open reduction and internal fixation of distal radius fractures by a volar approach at 2 Level I trauma centers between 2003 and 2015 were eligible. We measured radiographic outcomes and reviewed medical records to determine operative approach and complications. Results: There were 25 cases and 50 controls matched for age (18-87), sex, and AO fracture type. The delayed group had surgery at a mean of 24.8 days from injury and the early group at 5.6 days. There was no statistically significant difference between the delayed and early cohorts in radiographic parameters on injury x-rays, in improvement in radiographic parameters on first postoperative x-rays, or in maintenance of radiographic parameters at union. Conclusion: We did not find significant differences in radiographic outcomes or complication rates between patients with delayed versus early surgical treatment for distal radius fracture. Providers treating patients with late presentation or late displacement have the option of surgical fixation beyond the first few weeks after injury. Level of Evidence: III (Retrospective matched cohort study)

scholarly journals The diagnostic accuracy of ultrasonography in determining the reduction success of distal radius fractures

2018 ◽  
Vol 18 (3) ◽  
pp. 111-118
Author(s):  
Ozgur Bozkurt ◽  
Murat Ersel ◽  
Funda Karbek Akarca ◽  
Sercan Yalcinli ◽  
Sadiye Midik ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Radius Fractures

scholarly journals Arthroscopic Management of Intra-articular Ligament Lesions on Distal Radius Fractures

2021 ◽  
Vol 49 (01) ◽  
pp. 024-036
Author(s):  
Marcio Aurelio Aita ◽  
Ricardo Kaempf ◽  
Bruno Gianordoli Biondi ◽  
Gary Alan Montano ◽  
Fernando Towata ◽  
...  
Keyword(s):  
Return To Work ◽  
Distal Radius ◽  
Patient Reported Outcomes ◽  
Distal Radius Fractures ◽  
Joint Surface ◽  
Wrist Arthroscopy ◽  
X Rays ◽  
Radius Fractures ◽  
Patient Reported ◽  
The Mean

AbstractArticular distal radius fractures (DRFs) have increased in incidence in recent years, especially among the economically active population. Most of the treatment approaches are based on plain X- rays, and do not give us any information on how to treat these fractures. In the search for solutions with greater precision in diagnosis, in reducing the joint surface of the fracture, and envolving minimally-invasive techniques, we found arthroscopy as the main tool for these patients. Therefore, an enhanced understanding of the biomechanics of the different types of fracture associated with ligamentous lesions should facilitate the right decision regarding the treatment. The present paper aims at providing a management-oriented concept to diagnose and treat ligamentous lesions associated with intra-articular DRFs based on a arthroscopy-assisted procedure, and showing the objective and patient-reported outcomes and a new classification. The objective and patient-reported outcomes were: the mean range of motion (ROM) was of 94.80% on the non-affected side; the mean score on the abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) was of 3.6 (range: 1 to 12). The score on the Visual Analog Scale (VAS) was of 1.66 (range: 1 to 3). Complications were observed in 2 (13.33%) patients: extensor tendon synovitis in 1 patient, and a limitation (stiffness) in ROM in 1 patient, both treated with wrist arthroscopy release. The mean time until the return to work was of 6.4 weeks. In patients with unstable intra-articular DRFs associated with ligamentous lesions, the fixation of specific osseous-ligamentous fragments and ligamentous repair/reconstruction by wrist arthroscopy prove to be a safe and reliable treatment. The clinical and functional results predict that the patients can return to work more quickly.

The Reliability of Measurements Taken from Computer-Stored Digitalised X-Rays of Acute Distal Radius Fractures

2008 ◽  
Vol 33 (3) ◽  
pp. 369-372 ◽  
Author(s):  
K. THOMASON ◽  
K. L. SMITH
Keyword(s):  
Distal Radius ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Distal Radius Fractures ◽  
X Rays ◽  
Tolerance Limits ◽  
Radius Fractures ◽  
Distal Radial Fractures ◽  
Intraclass Correlation Coefficients ◽  
Anatomical Parameters

Sixteen observers measured eight anatomical parameters on digitalised images of six acute distal radial fractures using the Patient Archiving Communication System software and repeated the measurements at least 2 weeks later. Inter- and intraobserver reliability was calculated using intraclass correlation coefficients and tolerance limits. The highest interobserver agreement was demonstrated in the dorsal tilt (intraclass correlation coefficient 0.858; tolerance limit 14.2°). When compared with the results of a study looking at observer reliability in measurement of healed distal radial fractures, the reliability of computerised measurements is not significantly different from those achieved by manual techniques (dorsal tilt interobserver tolerance limits on computer system 16°, compared to 15° using ruler and protractor). These results suggest that the recommended radiological reduction limits for distal radius fractures of <10° change in palmar tilt, <2 mm radial shortening, <5° change in radial angle and a <1 to 2 mm articular step cannot be reliably measured.

Sign in / Sign up

Export Citation Format

Share Document