scholarly journals A Comparison of Intra-Observer and Inter-Observer Reliability of Plain Radiographs, Standard Computed Tomography Scans and Mobile Computed Tomography Scans in the Assessment of Distal Radius Fractures: A Cadaveric Study

2019 ◽  
pp. 53
Author(s):  
Sitthiphong Suwannaphisit ◽  
Saowapar Yoykaew ◽  
Chitchaya Suwanraksa ◽  
Varah Yuenyongviwat ◽  
Porames Suwanno ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Observer Agreement ◽  
Ct Scans ◽  
Radius Fractures ◽  
Plain Radiographs ◽  
Observer Reliability ◽  
Computed Tomography Scans ◽  
Mobile Ct

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. 

scholarly journals Is the Additional Effort for an Intraoperative CT Scan Justified for Distal Radius Fracture Fixations? A Comparative Clinical Feasibility Study

2020 ◽  
Vol 9 (7) ◽  
pp. 2254 ◽  
Author(s):  
Sascha Halvachizadeh ◽  
Till Berk ◽  
Alexander Pieringer ◽  
Emanuael Ried ◽  
Florian Hess ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Radiation Dose ◽  
Ct Scan ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Ct Scans ◽  
Radius Fractures ◽  
Ao Classification ◽  
Intraoperative Ct ◽  
Duration Of Surgery

Introduction: It is currently unclear whether the additional effort to perform an intraoperative computed tomography (CT) scan is justified for articular distal radius fractures (DRFs). The purpose of this study was to assess radiological, functional, and clinical outcomes after surgical treatment of distal radius fractures when using conventional fluoroscopy vs. intraoperative CT scans. Methods: Inclusion criteria: Surgical treatment of DRF between 1 January 2011 and 31 December 2011, age 18 and above. Group distribution: intraoperative conventional fluoroscopy (Group Conv) or intraoperative CT scans (Group CT). Exclusion criteria: Use of different image intensifier devices or incomplete data. DRF classification according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification. Outcome variables included requirement of revision surgeries, duration of surgery, absorbed radiation dose, and requirement of additional CT scans during hospitalization. Results: A total of 187 patients were included (Group Conv n = 96 (51.3%), Group CT n = 91 (48.7%)). AO Classification: Type A fractures n = 40 (50%) in Group Conv vs. n = 16 (17.6%) in Group CT, p < 0.001; Type B: 10 (10.4%) vs. 11 (12.1%), not significant (n.s.); Type C: 38 (39.6%) vs. 64 (70.3%), p < 0.001. In Group Conv, four (4.2%) patients required revision surgeries within 6 months, but in Group CT no revision surgery was required. The CT scan led to an intraoperative screw exchange/reposition in 23 (25.3%) cases. The duration of the initial surgery (81.7 ± 46.4 min vs. 90.1 ± 43.6 min, n.s.) was comparable. The radiation dose was significantly higher in Group CT (6.9 ± 1.3 vs. 2.8 ± 7.8 mGy, p < 0.001). In Group Conv, 11 (11.5%) patients required additional CT scans during hospitalization. Conclusion: The usage of intraoperative CT was associated with improved reduction and more adequate positioning of screws postoperatively with comparable durations of surgery. Despite increased efforts by utilizing the intraoperative CT scan, the decrease in reoperations may justify its use.

scholarly journals Extensor Tendon Entrapment on Computed Tomography Imaging of Distal Radius Fractures

2019 ◽  
Vol 09 (02) ◽  
pp. 129-135
Author(s):  
Evan D. Nigh ◽  
Christopher P. Emerson ◽  
David To ◽  
Spencer Barnhill ◽  
Michael G. Rizzo ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Distal Radius ◽  
Motor Vehicle ◽  
Ct Imaging ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Distal Radial Fractures ◽  
Level Of Evidence ◽  
Extensor Pollicis Longus ◽  
Tendon Entrapment

Abstract Objective To examine the association between distal radius fractures and tendon entrapment identified on computed tomography (CT) imaging. Patients and Methods After Institutional Review Board approval, we retrospectively reviewed distal radius fractures that underwent CT imaging from an electronic database between January 2006 to February 2018 at a single level 1 hospital trauma center. We categorized all distal radial fractures according to the AO-OTA (AO Foundation/Orthopaedic Trauma Association) classification. Distal upper extremity tendons were assessed for entrapment. Fisher's exact test was used for statistical analysis with significance at p < 0.05. Results A total of 183 distal radius fractures were identified in 179 patients. A total of 16 fractures (13 males and 3 females) were associated with tendon entrapment. Mechanism of injury included falls (n = 7), motor vehicle accidents (n = 6), dog bites (n = 2), and gunshot wound (n = 1). Entrapped tendons were limited to the extensor compartment and included the extensor pollicis longus (EPL; n = 11), extensor pollicis brevis (n = 1), extensor carpi ulnaris (n = 1), extensor carpi radialis longus (n = 1), and extensor digitorum communis (n = 2). The most commonly associated AO-OTA fracture pattern with tendon entrapment was complete articular radial fractures (2R3C; 69%), eight of which were simple articular with metaphyseal multifragmentary fractures (2R3C2). Of the distal radius fractures, 81% were associated with additional ulnar fractures of varying severity and displacement. Conclusion Approximately 8.7% of distal radius fractures were retrospectively identified to have tendon entrapment compared with a previously reported incidence of 1.3%. Wrist surgeons and radiologists should have higher suspicion for tendon entrapment and carefully review preoperative CT imaging for tendon entrapment in distal radius fractures especially if there is an intra-articular, multifragmentary injury pattern. Wrist surgeons and radiologists should also have increased suspicion for EPL tendon entrapments given its high incidence in association with distal radius fractures. Level of Evidence This is a Level III, retrospective cross-sectional study.

Dorsal Cortical Breaks in Volar Barton Distal Radius Fractures

Hand ◽  
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.

scholarly journals Assessment of the healing process in distal radius fractures by high resolution peripheral quantitative computed tomography

Bone ◽  
2014 ◽  
Vol 64 ◽  
pp. 65-74 ◽  
Author(s):  
Joost J.A. de Jong ◽  
Paul C. Willems ◽  
Jacobus J. Arts ◽  
Sandrine G.P. Bours ◽  
Peter R.G. Brink ◽  
...  
Keyword(s):  
Computed Tomography ◽  
High Resolution ◽  
Distal Radius ◽  
Healing Process ◽  
Quantitative Computed Tomography ◽  
Peripheral Quantitative Computed Tomography ◽  
Distal Radius Fractures ◽  
Radius Fractures

Computed tomography scanning of intra-articular distal radius fractures: Does it influence treatment?

2001 ◽  
Vol 26 (3) ◽  
pp. 415-421 ◽  
Author(s):  
Mark A. Katz ◽  
Pedro K. Beredjiklian ◽  
David J. Bozentka ◽  
David R. Steinberg
Keyword(s):  
Computed Tomography ◽  
Distal Radius ◽  
Distal Radius Fractures ◽  
Radius Fractures ◽  
Computed Tomography Scanning ◽  
Tomography Scanning

Computed tomography improves intra-observer reliability, but not the inter-observer reliability of the Eaton–Glickel classification

2012 ◽  
Vol 38 (2) ◽  
pp. 187-191 ◽  
Author(s):  
T. B. Hansen ◽  
O. G. Sørensen ◽  
L. Kirkeby ◽  
M. Homilius ◽  
A. L. Amstrup
Keyword(s):  
Computed Tomography ◽  
Degenerative Changes ◽  
Bone Cysts ◽  
Trapeziometacarpal Joint ◽  
Plain Radiographs ◽  
Observer Reliability ◽  
Computed Tomography Scans ◽  
Trapeziometacarpal Joint Osteoarthritis ◽  
The Mean

This study aimed to evaluate whether computed tomography improves the intra- and inter-observer reliability of the Eaton–Glickel classification of trapeziometacarpal joint osteoarthritis. The osteoarthritis of the trapeziometacarpal joint was evaluated with conventional radiographs and computed tomography by two hand surgeons, two registrars and one radiologist in 50 hands of 43 patients (12 male and 31 female) who had a median age of 60 years (46–80). Using plain radiographs, we found a mean intra-observer reliability of 0.54 (0.51–0.74), and the intra-observer reliability was improved to 0.76 (0.64–0.86) using computed tomography. Using plain radiographs, the mean inter-observer reliability was poor at 0.17 (0.04–0.51) and did not improve using computed tomography with a mean inter-observer reliability of 0.22 (0.02–0.38). In particular, the agreement in the distinction between Eaton–Glickel stage III and IV and the evaluation of the degenerative changes in the scaphotrapezio joint was low using computed tomography-scans. The detection of bone cysts on computed tomography was more precise than on plain radiographs.

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