Computed Tomography's Influence on the Classifications and Treatment of the Distal Radius Fractures

Abstract

Introduction Distal radius fractures are common in emergency centers. The radiographic routine includes at least two radiographic projections used for diagnosing most of these fractures. Computed tomography (CT) is indicated for evaluating complex fractures that affect the articular surface, as well as the fragments' size and position. There are not enough comparative studies on choosing classification and treatment by means of the four radiographic projections and computed tomography (CT) and the association of these with the levels of expertise. Methods We conducted a randomized cross-sectional study by observing images from 61 patients with distal radius fractures organized in two phases: the first phase comprising radiographic images alone and the second one with those same images associated with tomograms. Seventeen evaluators with different levels of training and expertise classified the fractures according to the AO and Universal classification systems and proposed treatment guidelines. Results The agreement between the AO and Universal classification ratings was poor (worse for the former), with smaller Fleiss' kappa resulting from data obtained by orthopedics residents and non-specialist orthopedists. CT influenced the classification choice, with a higher change frequency for more complex patterns in the AO classification system and intraarticular and irreducible fractures in the Universal classification system, especially in the group comprised of orthopedic residents and orthopedic physicians. CT did not influence the treatment choice made by the group comprised of hand surgery residents and hand surgeons. Conclusion The less experienced in hand surgery the observer was, the more important computed tomography was for determining the fracture pattern.

Single-shot CT after wrist trauma: impact on detection accuracy and treatment of fractures

“…We found therapeutic changes in a substantial proportion (varying between 24 and 31% for different observers) and we saw a trend towards better interobserver agreement on treatment planning after CT diagnosis. This is concordant with other studies on variations in wrist fracture treatments in selected populations, especially with less experienced observers [ 19 , 20 ], but this is discordant with a study that compared CT to traction CR and did not find a significant impact on treatment choices, again in a selected patient population [ 21 ].…”

“…We therefore considered the treatment plans from emergency physicians in clinical practice not definite enough to be part of the main outcome parameter of the study. The observer study guaranteed a more controlled set up, with experienced observers with equal access to patient information, but still demonstrated differences in surgeon preferences, in line with previous publications [ 20 ]. Fourth, we used a standard of reference both including clinical follow-up and questionnaires, but we had a low response rate to the questionnaires and no standard patient visit during follow-up.…”

Does pisiform subluxation affect the postoperative outcomes in a cohort of patients with distal radius fractures?

“…DRF are common traumas, examined not only by hand surgeons but also orthopedists. Imaging using computed tomography (CT) as well as plain radiography has become generally used to judge the fracture type [ 4 ], with which collection of detailed information on not only distal radius fractures but also fractures and subluxation of the carpal bone has become possible.…”

Proposal Tomographic Classification for Intra-Articular Distal Radius Fractures

“…Given that the majority of classification systems used worldwide are based on observation of plain radiographs in two views, and drawing on previous studies by the Hand Surgery and Microsurgery Group investigating the influence of computed tomography on classifications and on treatment options for distal radius fractures, 5 it was decided to propose a classification based on intra-articular fragments observed in tomographic images on sagittal, coronal and axial planes.…”