Can experienced surgeons predict the additional value of a CT scan in patients with displaced intra-articular distal radius fractures?

Abstract

There are no clear guidelines when an additional CT scan should be obtained for the treatment of displaced intra-articular distal radius fractures (DRF). This study aimed to investigate whether surgeons can predict the usefulness of CT scans to facilitate choice of treatment plan and/or pre-operative planning for DRF. Four surgeons evaluated 51 patients with displaced DRF. The choice of treatment (operative or nonoperative) was based on conventional radiographs. Subsequently, the surgeons were asked whether they would have requested an additional CT scan to determine this treatment choice, and also whether they required a CT scan for pre-operative planning. After 4 weeks, the additional CT scan was provided and the cases were assessed again. Based on these data, we calculated the number needed to scan (NNS) and number needed to harm (NNH) for two decision models. Model 1: Only provide a CT scan if the surgeon requested one based on their judgment of the X-rays. Model 2: CT scans for all displaced intra-articular DRF. For choice of treatment, the NNS was lower for model 1 than for model 2 (2.6 vs. 4.3) and the NNH is higher for model 1 (3.1 vs. 1.3). For pre-operative planning, the NNS (1.3 vs. 1.4) and NNH (3.7 vs. 3.4) were comparable for both models. Surgeons are able to predict the usefulness of an additional CT scan for intra-articular displaced DRF for OR indication. However, for pre-operative planning the usefulness of a CT scan is much harder to predict.

Distal Radius Fracture Management: Surgeon Factors Markedly Influence Decision Making

“…It has been found that experienced surgeons can predict the usefulness of CT scans for intra-articular displaced DRFs to decide on treatment, but for preoperative planning, the usefulness of CT scans is much harder to predict. 18 Although our study did not address potential reasons that address the causation between surgical experience with the likeliness of obtaining a CT and choosing an surgical intervention, several reasons may explain this effect. Experienced surgeons likely have greater exposure to evidence regarding the relative effectiveness of treatment strategies for DRFs.…”

Computed Tomography vs Standard Radiograph in Preoperative Planning of Distal Radius Fractures with Articular Involvement

“…However, for preoperative planning, the usefulness of the computed tomography is much harder to predict. 11 das GraçasNascimento et al 30 also showed the relationship between surgeon experience and the need for a computed tomography. They found that computed tomography had minimal impact on the selection of treatment recommended by specialists and hand surgery residents but it was more useful for those less experienced in hand surgery.…”

“…As a result, the treatment plan was altered in 48% of the cases with an increase in recommendations for surgical treatment. 10 Kleinlugtenbelt et al 11 found that experienced surgeons can predict the usefulness of the computed tomography for the treatment of the intra-articular distal radius fractures. However, for preoperative planning, the usefulness of the computed tomography is much harder to predict.…”

“…Thus, several authors have questioned whether computed tomography could contribute in treatment selection. [8][9][10][11] The objective of this study was to determine the differences between bi-dimensional computed tomography and standard radiographs in the preoperative planning of surgical treatment of distal radius fractures with articular involvement. This was performed by measuring the intraobserver and interobserver reliability between three systems that were used to determine the main fracture characteristics (AO/OTA fracture and dislocation classification system, key articular fragments and biomechanical columns) and two treatment decisions (surgical approach and implant selection).…”