Clinical Orthopaedics and Related Research®

, Volume 470, Issue 7, pp 2029–2034 | Cite as

Training Improves Interobserver Reliability for the Diagnosis of Scaphoid Fracture Displacement

  • Geert A. Buijze
  • Thierry G. Guitton
  • C. Niek van Dijk
  • David RingEmail author
  • The Science of Variation Group
Clinical Research



The diagnosis of displacement in scaphoid fractures is notorious for poor interobserver reliability.


We tested whether training can improve interobserver reliability and sensitivity, specificity, and accuracy for the diagnosis of scaphoid fracture displacement on radiographs and CT scans.


Sixty-four orthopaedic surgeons rated a set of radiographs and CT scans of 10 displaced and 10 nondisplaced scaphoid fractures for the presence of displacement, using a web-based rating application. Before rating, observers were randomized to a training group (34 observers) and a nontraining group (30 observers). The training group received an online training module before the rating session, and the nontraining group did not. Interobserver reliability for training and nontraining was assessed by Siegel’s multirater kappa and the Z-test was used to test for significance.


There was a small, but significant difference in the interobserver reliability for displacement ratings in favor of the training group compared with the nontraining group. Ratings of radiographs and CT scans combined resulted in moderate agreement for both groups. The average sensitivity, specificity, and accuracy of diagnosing displacement of scaphoid fractures were, respectively, 83%, 85%, and 84% for the nontraining group and 87%, 86%, and 87% for the training group. Assuming a 5% prevalence of fracture displacement, the positive predictive value was 0.23 in the nontraining group and 0.25 in the training group. The negative predictive value was 0.99 in both groups.


Our results suggest training can improve interobserver reliability and sensitivity, specificity and accuracy for the diagnosis of scaphoid fracture displacement, but the improvements are slight. These findings are encouraging for future research regarding interobserver variation and how to reduce it further.


Training Group Interobserver Reliability Displace Fracture Scaphoid Fracture Interobserver Variation 
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Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  • Geert A. Buijze
    • 1
  • Thierry G. Guitton
    • 1
  • C. Niek van Dijk
    • 1
  • David Ring
    • 2
    Email author
  • The Science of Variation Group
  1. 1.Orthopaedic Research Center Amsterdam, Department of Orthopaedic SurgeryAcademic Medical CentreAmsterdamThe Netherlands
  2. 2.Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical SchoolYawkey CenterBostonUSA

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