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Multiplanar reconstruction computed tomography for diagnosis of scaphoid waist fracture union: a prospective cohort analysis of accuracy and precision

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Abstract

Objective

To examine reliability and validity concerning union of scaphoid fractures determined by multiplanar reconstruction computed tomography randomized at 6, 12, and 24 weeks after injury.

Materials and methods

We used Fleiss’ kappa to measure the opinions of three observers reviewing 44 sets of computed tomographic scans of 44 conservatively treated scaphoid waist fractures. We calculated kappa for the extent of consolidation (0–24 %, 25–49 %, 50–74 %, or 75–100 %) on the transverse, sagittal and coronal views. We also calculated kappa for no union, partial union, and union, and grouped the results for 6, 12, and 24 weeks after injury. As the reference standard for union, CT scans were performed at a minimum of 6 months after injury to determine validity.

Results

Overall inter-observer agreement was found to be moderate (κ = 0.576). No union (κ = 0.791), partial union (κ = 0.502), and union (κ = 0.683) showed substantial, moderate, and substantial agreement, respectively. The average sensitivity of multiplanar reconstruction CT for diagnosing union of scaphoid waist fractures was 73 %. The average specificity was 80 %.

Conclusions

Our results suggest that multiplanar reconstruction computed tomography is a reliable and accurate method for diagnosing union or nonunion of scaphoid fractures. However, inter-observer agreement was lower with respect to partial union.

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Acknowledgments

This work was supported by a research grant from the Netherlands Organisation for Health Research and Development (ZonMw, reference 171001004)

Conflict of interest

All authors declare that they have no conflicts of interest to disclose or any financial relationships with any organization that contributed to this study.

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Authors and Affiliations

  1. Department of Surgery and Traumasurgery, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands

    P. F. W. Hannemann, L. Brouwers, K. W. A. Gottgens, M. Poeze & P. R. G. Brink

  2. Department of radiology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands

    D. van der Zee, A. Stadler & R. Weijers

Authors
  1. P. F. W. Hannemann
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  2. L. Brouwers
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  3. D. van der Zee
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  4. A. Stadler
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  5. K. W. A. Gottgens
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  6. R. Weijers
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  7. M. Poeze
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  8. P. R. G. Brink
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Correspondence to P. F. W. Hannemann.

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Hannemann, P.F.W., Brouwers, L., van der Zee, D. et al. Multiplanar reconstruction computed tomography for diagnosis of scaphoid waist fracture union: a prospective cohort analysis of accuracy and precision. Skeletal Radiol 42, 1377–1382 (2013). https://doi.org/10.1007/s00256-013-1658-8

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  • DOI: https://doi.org/10.1007/s00256-013-1658-8

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