AO type-C distal radius fractures: the influence of computed tomography on surgeon's decision-making

Authors

  • Joshua J. Hunt,

    1. Department of Orthopaedics, John Hunter Hospital and University of Newcastle, Newcastle, New South Wales, Australia
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  • William Lumsdaine,

    1. Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, New South Wales, Australia
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  • John Attia,

    1. Department of Medicine, John Hunter Hospital and University of Newcastle, Newcastle, New South Wales, Australia
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  • Zsolt J. Balogh

    Corresponding author
    1. Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, New South Wales, Australia
    • Department of Orthopaedics, John Hunter Hospital and University of Newcastle, Newcastle, New South Wales, Australia
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  • J. J. Hunt MBBS; W. Lumsdaine BMed; J. Attia MD, PhD, FRACP; Z. J. Balogh MD, PhD, FRACS.

Correspondence

Professor Zsolt J. Balogh, Department of Traumatology, John Hunter Hospital and University of Newcastle, Locked Bag 1, Hunter Region Mail Centre, Newcastle, NSW 2310, Australia. Email: zsolt.balogh@hnehealth.nsw.gov.au

Abstract

Background

Computed tomography (CT) has become a widely accepted adjunct imaging tool in the preoperative evaluation of complex intra-articular distal radius fractures. The aim of this study was to evaluate the impact of CT scanning compared with plain X-rays on the choice of intervention in complex distal radius fractures.

Methods

Five orthopaedic surgeons were given the de-identified plain films (AP, lateral and oblique) of 20 closed complex intra-articular distal radius fractures (AO23-C), randomly selected from our institution's prospectively maintained fracture database. Each surgeon individually selected a management option for each patient from a series of five interventions, ranked in increasing level of invasiveness. The same patients' CT scans (in randomized order) were blindly reviewed after a 1-week interval by the same clinicians with the same management options again offered. Kappa statistic was used to measure the intra-observer agreement between X-ray and CT decisions, and inter-observer agreement within each modality.

Results

The intra-observer agreement on management between X-rays alone versus CT scan was poor, with an average kappa score of 0.038. Inter-observer agreement based on X-ray alone was higher than that based on CT alone. Regression analysis indicated a trend towards a slightly higher level of invasiveness when the management decision was based on the CT compared with plain X-rays.

Conclusion

There is a very poor intra- and inter-rater agreement between decision-making based on X-ray and on CT. Decision-making based on CT could increase the level of invasiveness in the surgical management of complex distal radius fractures.

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