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Radiographs Versus Radiographic Measurements in Distal Radius Fractures

  • Original Article
  • Published:
Journal of Hand and Microsurgery

Abstract

Surgeons use radiographic measures of deformity to help make treatment decisions in distal radius fractures. Precise threshold values are sometimes offered as a guide to treatment. The purpose was to evaluate if agreement on treatment recommendations would improve if surgeons were provided with radiographs rather than precise numeric radiographic measurements. We randomized 259 surgeons to review the scenarios of 30 consecutive adult patients with a distal radius fracture treated at our emergency department either with radiographs (135 surgeons) or with radiographic measurements (124 surgeons). Interrater reliability was measured with the Fleiss’ generalized Kappa. Factors associated with a recommendation for operative treatment were sought in bivariate and multivariable analyses. Surgeons that received measurements only recommended operative treatment significantly more often, but were less likely to agree than surgeons evaluating actual radiographs. Patient factors - radiographic factors in particular - had a greater influence on treatment recommendation than surgeon factors. Agreement on treatment recommendations improved if surgeons were provided with radiographs instead of just measurements. There may be radiographic factors other than measures of deformity that some surgeons use to determine recommendations for surgery.

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References

  1. Ilyas AM, Jupiter JB (2007) Distal radius fractures–classification of treatment and indications for surgery. Orthop Clin North Am 38(2):167–173. doi:10.1016/j.ocl.2007.01.002

    Article  PubMed  Google Scholar 

  2. Diaz-Garcia RJ, Oda T, Shauver MJ, Chung KC (2011) A systematic review of outcomes and complications of treating unstable distal radius fractures in the elderly. J Hand Surg Am 36(5):824–835. doi:10.1016/j.jhsa.2011.02.005, e822

    Article  PubMed Central  PubMed  Google Scholar 

  3. Guitton TG, Ring D, Science of Variation G (2011) Interobserver reliability of radial head fracture classification: two-dimensional compared with three-dimensional CT. J Bone Joint Surg Am 93(21):2015–2021. doi:10.2106/JBJS.J.00711

    Article  PubMed  Google Scholar 

  4. Andersen DJ, Blair WF, Steyers CM, Jr Adams BD, el-Khouri GY, Brandser EA (1996) Classification of distal radius fractures: an analysis of interobserver reliability and intraobserver reproducibility. J Hand Surg Am 21(4):574–582

    Article  CAS  PubMed  Google Scholar 

  5. Neuhaus V, Bot AG, Guitton TG, Ring DC, Science of Variation G (2014) Scapula fractures: interobserver reliability of classification and treatment. J Orthop Trauma 28(3):124–129. doi:10.1097/BOT.0b013e31829673e2

    Article  PubMed  Google Scholar 

  6. Thomason K, Smith KL (2008) The reliability of measurements taken from computer-stored digitalised x-rays of acute distal radius fractures. J Hand Surg Eur 33(3):369–372. doi:10.1177/1753193407087509

    Article  CAS  Google Scholar 

  7. Guitton TG, Ring D (2011) Interobserver reliability of radial head fracture classification: two-dimensional compared with three-dimensional CT. J Bone Joint Surg Am 93(21):2015–2021. doi:10.2106/JBJS.J.00711

    Article  PubMed  Google Scholar 

  8. Venkataraman G, Ananthanarayanan V, Paner GP (2006) Accessible calculation of multirater kappa statistics for pathologists. Virchows Arch 449(2):272. doi:10.1007/s00428-006-0209-2

    Article  PubMed  Google Scholar 

  9. King JE Generalized Kappa & Other Indices of Interrater Reliability. http://www.ccitonline.org/jking/homepage/interrater.html. Accessed November 1st, 2012

  10. Hallgren KA (2012) Computing inter-rater reliability for observational data: an overview and tutorial. Tutor Quant Methods Psychol 8(1):23–34

    PubMed Central  PubMed  Google Scholar 

  11. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174

    Article  CAS  PubMed  Google Scholar 

  12. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383

    Article  CAS  PubMed  Google Scholar 

  13. Kirkland LL, Kashiwagi DT, Burton MC, Cha S, Varkey P (2011) The Charlson Comorbidity Index Score as a predictor of 30-day mortality after hip fracture surgery. Am J Med Qual 26(6):461–467. doi:10.1177/1062860611402188

    Article  PubMed  Google Scholar 

  14. Robertson GA, Robertson BF, Thomas B, McEachan J, Davidson DM (2011) Assessing angulation on digital images of radiographs of fractures of the distal radius: visual estimation versus computer software measurement. J Hand Surg Eur 36(3):230–235. doi:10.1177/1753193410391361

    Article  CAS  Google Scholar 

  15. Gaskin JS, Pimple MK, Wharton R, Fernandez C, Gaskin D, Ricketts DM (2007) How accurate and reliable are doctors in estimating fracture angulation? Injury 38(2):160–162. doi:10.1016/j.injury.2006.09.008

    Article  CAS  PubMed  Google Scholar 

  16. Wigderowitz CA, Sadaiyappan V, McGurty DM, Rowley DI (2001) Computerized analysis of radiographs in Colles’ fractures. Clin Orthop Relat Res 387:217–224

    Article  PubMed  Google Scholar 

  17. Grainger AJ, Duryea J, Elliott JM, Genant HK (2002) The evaluation of a new digital semi-automated system for the radiological assessment of distal radial fractures. Skeletal Radiol 31(8):457–463. doi:10.1007/s00256-002-0526-8

    Article  CAS  PubMed  Google Scholar 

  18. Ilyas AM, Jupiter JB (2010) Distal radius fractures–classification of treatment and indications for surgery. Hand Clin 26(1):37–42. doi:10.1016/j.hcl.2009.08.003

    Article  PubMed  Google Scholar 

  19. Rajabi B, Roed O, Roed K, Alm-Paulsen PS, Russwurm H, Finsen V (2011) Accurate radiographic measurement of the distal radial tilt. Hand Surg 16(3):259–262

    Article  PubMed  Google Scholar 

  20. Kreder HJ, Hanel DP, McKee M, Jupiter J, McGillivary G, Swiontkowski MF (1996) X-ray film measurements for healed distal radius fractures. J Hand Surg Am 21(1):31–39. doi:10.1016/S0363-5023(96)80151-1

    Article  CAS  PubMed  Google Scholar 

  21. Medoff RJ (2005) Essential radiographic evaluation for distal radius fractures. Hand Clin 21(3):279–288. doi:10.1016/j.hcl.2005.02.008

    Article  PubMed  Google Scholar 

  22. Chung KC, Shauver MJ, Birkmeyer JD (2009) Trends in the United States in the treatment of distal radial fractures in the elderly. J Bone Joint Surg Am 91(8):1868–1873. doi:10.2106/JBJS.H.01297

    Article  PubMed Central  PubMed  Google Scholar 

  23. Chung KC, Shauver MJ, Yin H (2011) The relationship between ASSH membership and the treatment of distal radius fracture in the United States Medicare population. J Hand Surg Am 36(8):1288–1293. doi:10.1016/j.jhsa.2011.05.028

    Article  PubMed  Google Scholar 

  24. Koval KJ, Harrast JJ, Anglen JO, Weinstein JN (2008) Fractures of the distal part of the radius. The evolution of practice over time. Where’s the evidence? J Bone Joint Surg Am 90(9):1855–1861. doi:10.2106/JBJS.G.01569

    Article  PubMed  Google Scholar 

  25. Kodama N, Takemura Y, Ueba H, Imai S, Matsusue Y (2014) Acceptable parameters for alignment of distal radius fracture with conservative treatment in elderly patients. J Orthop Sci 19(2):292–297. doi:10.1007/s00776-013-0514-y

    Article  CAS  PubMed  Google Scholar 

  26. Mackenney PJ, McQueen MM, Elton R (2006) Prediction of instability in distal radial fractures. J Bone Joint Surg Am 88(9):1944–1951. doi:10.2106/JBJS.D.02520

    Article  CAS  PubMed  Google Scholar 

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Ethical Standards

All named authors hereby declare that they have no direct conflicts of interest to disclose related to this study. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. The study was completed under an IRB approved protocol.

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Authors and Affiliations

  1. Orthopaedic Hand Service, Yawkey Center, Suite 2100, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA

    Valentin Neuhaus, Arjan G. Bot, Thierry G. Guitton & David C. Ring

  2. Division of Trauma Surgery, UniversityHospital Zurich, Zurich, CH-8091, Switzerland

    Valentin Neuhaus

Authors
  1. Valentin Neuhaus
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  2. Arjan G. Bot
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  3. Thierry G. Guitton
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  4. David C. Ring
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Corresponding author

Correspondence to David C. Ring.

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Science of variation group

A.B... Spoor, Abhay Shrivastava, Adam B. Shafritz, Aida E. Garcia G., Amy Ladd, Andrew S. Neviaser, Andrew Schmidt, Antonio Barquet, Anze Kristan, Apard T., Arne Berner, Ashok K. Shyam, Asif Ilyas, Axel Jubel, B.E. Kreis, Betsy M. Nolan, Brett D. Crist, Brian J. Cross, Brian PD Wills, Camilo Jose Romero Barreto, Carl Ekholm, Carrie Swigart, Cesar Dario Oliveira Miranda, Chad Manke, Charalampos Zalavras, Charles Cassidy, Charles Cornell, Charles Metzger, Chris Wilson, Christopher G. Finkemeier, Christopher J. Wall, Christopher J. Walsh, Christopher J. Wilson, Christopher M. Jones, Christos Garnavos, Constanza L. Moreno-Serrano, Cyrus Klostermann, Daniel A. Osei, Daniel Haverkamp, Daniel Polatsch, David L. Nelson, David M. Kalainov, David Ruchelsman, Denise Eygendaal, Desirae M. McKee, D.F.P. van Deurzen, Diederik O.F. Verbeek, Gertraud Gradl, Minoo Patel, Drago Brilej, E.T. Walbeehm, Edward Harvey, Emilija Stojkovska Pemovska, Eran Maman, Eric Hofmeister, Eric L.L. Twiss, Eric Mark Hammerberg, Eric T. Tolo, Evan D. Schumer, F. Thomas D. Kaplan, Fabio Suarez, C.H. Fernandes, Fernando García, Filip Celestyn Dolatowski, Forigua Jaime E., Francisco Javier Aguilar Sierra, Frank L. Walter, Frede Frihagen, G.A. Kraan, Georg M. Huemer, George Kontakis, George S. Athwal, George S.M. Dyer, George W. Balfour, Georges Kohut, German Ricardo Hernandez, Grant Garrigues, Grant J Bayne, Gregory DeSilva, Gregory J. Della Rocca, Gustavo Mantovani Ruggiero, H. Brent Bamberger DO, H.W. Grunwald, Hans Goost, Harrison Solomon, Henry Broekhuyse, Hervey L. Kimball, Huub van der Heide, Iain McGraw, Ian Harris, J. Daniel Espinosa Esparza, Jack Choueka, Jack Elias Kazanjian, Jaimo Ahn, James F. Nappi, James Kellam, Jan Biert, Jason C. Fanuele, Jeffrey Abrams, Jeffrey Wint, Jennifer L. Giuffre, Jennifer Moriatis Wolf, Jesus Moreta-Suarez, Jim Calandruccio, Job N. Doornberg, Jochen Fischer, Johan H Scheer, John M. Erickson, John McAuliffe, John T. Capo, Jorge G. Boretto, Jorge Rubio, Jose A. Ortiz, Jr, Jose Eduardo Grandi Ribeiro Fil, José Fernando Di Giovanni, Jose Nolla, Joseph M. Conflitti, Joshua M. Abzug, Juan M Patiño, Julie Adams, Julius Bishop, Kabir K., Karel Chivers, Karl-Josef Prommersberger, Kendrick Lee, Kenneth Egol, Kevin J. Malone, Kevin M. Rumball, Kleinlugtenbelt, Kyle Dickson, Kyle Jeray, l Marsh, L.M.S.J. Poelhekke, Ladislav Mica, Lars E. Adolfsson, Lawrence Weiss, Lior Paz, Lisa Lattanza, Lob Guenter, Loren Potter, Louis Catalano III, Luiz Augusto B. Campinhos, P. Lygdas, M. Jason Palmer, Mahmoud I. Abdel-Ghany, M.A.J. van de Sande, Marc J. Richard, Marc Swiontkowski, Marco Rizzo, Marijke Oidtmann, Marinis Pirpiris, Martin Boyer, Martin Richardson, Matt Mormino, Matthew D. Budge, Matthew Menon, Maurizio Calcagni, Megan M. Wood, S.A. Meylaerts, Michael Behrman, Michael Darowish, Michael Jones, Michael Nancollas, Michael Prayson, Michael W. Grafe, Michael W. Kessler, Michel P. J. van den Bekerom, Milind Merchant, Minos Tyllianakis, Mohamed Shafi, Naquira Escobar Luis Felipe, Nata Parnes, Neal C. Chen, Neeraj Bijlani, Neil Saran, Neil Wilson, Nelson Elias, Ngozi M. Akabudike, Nicholas L. Shortt, Nicky L. Leung, Niels Schep, Nigel William Gummerson, Nikolaos G. Lasanianos, Nikolaos K. Kanakaris, Oleg M. Semenkin, P.V. van Eerten, Patrick W. Owens, Paul A. Martineau, Peter Althausen, Peter Hahn, Peter Jebson, Peter Kloen, Peter Schandelmaier, Philip Blazar, Platz Andreas, Prashanth Inna, Prosper Benhaim, M. Quell, R. Glenn Gaston, R. Haverlag, R.A.W. Verhagen, R.W. Peters, Ralf Nyszkiewicz, Ralph M. Costanzo, Ramon de Bedout, Ashish S. Ranade, Randy Hauck, Raymond Malcolm Smith, Renato M. Fricker, Reto H. Babst, Reza Omid, Richard Jenkinson, Richard L. Hutchison, Richard S. Gilbert, Richard S. Page, Rick Papandrea, Robert D. Zura, Robert R. Slater, Jr., Robert R.L. Gray, Rodrigo Pesantez, Roger van Riet, Ronald Liem, Rozental, Russell Shatford, Ryan Klinefelter, Ryan P. Calfee, Samir Mehta, Samir Sodha, Sander Spruijt, Sanjeev Kakar, Saul Kaplan, Scott F. Duncan, Scott G. Kaar, Scott Mitchell, Seth Dodds, Stephen A. Kennedy, Steven Beldner, Stuart Hilliard, Taco Gosens, Taizoon Baxamusa, C. Taleb, Theodoros Tosounidis, Thierry Begue, Thomas DeCoster, Thomas Dienstknecht, Thomas Higgins, Thomas Hughes, Thomas Mittlmeier, Timothy Omara, Todd Siff, Tomo Havliček, Vasileios S. Nikolaou, Vincenzo Giordano, A.J.H. Vochteloo, W. Arnold Batson, Warren C. Hammert, Wojciech Satora, Yoram Weil

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Neuhaus, V., Bot, A.G., Guitton, T.G. et al. Radiographs Versus Radiographic Measurements in Distal Radius Fractures. J Hand Microsurg 7, 42–48 (2015). https://doi.org/10.1007/s12593-014-0164-0

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  • DOI: https://doi.org/10.1007/s12593-014-0164-0

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