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Skeletal Radiology

, Volume 41, Issue 10, pp 1239–1244 | Cite as

Introduction of an alternative standardized radiographic measurement method to evaluate volar angulation in subcapital fractures of the 5th metacarpal

  • Thomas Hoffelner
  • Herbert Resch
  • Philipp Moroder
  • Gundobert Korn
  • Felix Steinhauer
  • Jörg Atzwanger
  • Bernd Minnich
  • Mark Tauber
Scientific Article

Abstract

Objective

The purpose of the present study was to compare the intra- and interobserver reliability of two different measurement methods for volar angulation of the 5th metacarpal (MC) in an attempt to establish a new standard measurement method to reduce interobserver discrepancies for therapeutic decisions.

Materials and methods

Twenty patients with subcapital fractures of the 5th MC were radiologically investigated. Imaging consisted of a radiographs in antero-posterior and precise lateral view in addition to a CT scan of the 5th MC. Measurement of volar angulation was accomplished using the conventional and the shaft articular surface (SAS) method. The measurements of five investigators were exported to a spreadsheet for statistical analysis to evaluate the intra-and interobserver reliability.

Results

The conventional technique showed large differences among the investigators and poor interobserver reliability (W = 0.328 and 0.307) both at injury (p = 0.001) and at follow-up (p = 0.189). The intraobserver concordance of all investigators showed better results with the SAS than with the conventional technique. With the SAS technique, no statistically significant difference among the investigators could be detected at either the time of injury (p = 0.418) or at follow-up (p = 0.526) with excellent interobserver reliability (W = 0.051 and W = 0.041). Evaluation of volar angulation at follow-up using CT scans did not show any statistically significant difference between the techniques with better correlation among the observers with the SAS technique (p = 0.838).

Conclusions

The interobserver correlation of volar angulation with lateral radiographs using the conventional technique was insufficient. Therefore, we recommend the use of the novel SAS technique as standardized measurement method which showed higher accuracy and interobserver reliability in order to facilitate the choice of adequate treatment option.

Clinical relevance

A CT scan should be performed in cases with ambivalent treatment options.

Level of evidence

Evidence-Based Medicine Level II

Keywords

5th metacarpal Subcapital fracture Volar angulation Measurement technique Inter- and intraobserver reliability 

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Copyright information

© ISS 2012

Authors and Affiliations

  • Thomas Hoffelner
    • 1
  • Herbert Resch
    • 1
  • Philipp Moroder
    • 1
  • Gundobert Korn
    • 1
  • Felix Steinhauer
    • 1
  • Jörg Atzwanger
    • 2
  • Bernd Minnich
    • 3
  • Mark Tauber
    • 4
  1. 1.Department of Traumatology and Sports InjuriesUniversity of SalzburgSalzburgAustria
  2. 2.Department of RadiologyUniversity of SalzburgSalzburgAustria
  3. 3.Department of Organismic BiologyUniversity of SalzburgSalzburgAustria
  4. 4.Shoulder and Elbow Surgery ATOS Clinic MunichMunichGermany

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