Radiographic Diagnosis of Scapholunate Dissociation Among Intra-articular Fractures of the Distal Radius: Interobserver Reliability

Gradl, Gertraud; Neuhaus, Valentin; Fuchsberger, Thomas; Guitton, Thierry G.; Prommersberger, K.-J.; Ring, David

doi:10.1016/j.jhsa.2013.05.039

Cited by 30 publications

(21 citation statements)

References 17 publications

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“…Therefore it is difficult to draw firm conclusions on the usefulness of this parameter. Overall interobserver agreement for assessment of morphologic features of a middle phalanx base fracture was much greater than other anatomic areas (humerus, elbow, clavicle, and olecranon) [1,2,5,8,10]. We found only fair agreement, indicating variation, regarding specific proposed treatments, which might be a reflection of the lack of high-level evidence and relatively small case series on which surgeons base their decisions [7].…”

Section: Discussionmentioning

confidence: 70%

“…Putting aside whether the criteria for recommending operative treatment of a proximal interphalangeal joint fracturedislocation are useful and accurate thresholds, if observers cannot agree on the criteria (unreliable) they may not be useful. Studies of fractures at other anatomic sites (such as the humerus, clavicle, and olecranon) showed that some fracture characteristics are assessed more reliably than others [1,2,5,8,10]. In addition to measuring the reliability of radiographic criteria for recommending operative treatment, better understanding of the criteria that have the greatest influence on recommendation for treatment of middle phalanx base fractures would help direct the development of guidelines and measurement techniques for those criteria.…”

Section: Introductionmentioning

confidence: 99%

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What Middle Phalanx Base Fracture Characteristics are Most Reliable and Useful for Surgical Decision-making?

Janssen

Molleman

Guitton

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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BackgroundFracture-dislocations of the proximal interphalangeal joint are vexing because subluxation and articular damage can lead to arthrosis and the treatments are imperfect. Ideally, a surgeon could advise a patient, based on radiographs, when the risk of problems merits operative intervention, but it is unclear if middle phalanx base fracture characteristics are sufficiently reliable to be useful for surgical decision making. Questions/purposesWe evaluated (1) the degree of interobserver agreement as a function of fracture characteristics, (2) the differences in interobserver agreement between experienced and less-experienced hand surgeons, and (3) what fracture characteristics and surgeon characteristics were associated with the decision for operative treatment. Methods Ninety-nine (33%) of 296 hand surgeons evaluated 21 intraarticular middle phalanx base fractures on lateral radiographs. Eighty-one surgeons (82%) were in academic practice and 57 (58%) had less than 10 years experience. Participants assessed six fracture characteristics and recommended treatment (nonoperative or operative: One of the authors (DR) certifies that he, or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount less than USD 10,000 from Wright Medical (Memphis, TN, USA); an amount less than USD 10,000 from Skeletal Dynamics (Miami, FL, USA); an amount less than USD 10,000 from Biomet (Warsaw, IN, USA); an amount less than USD 10,000 from AO North America (Paoli, PA, USA); and an amount less than USD 10,000 from AO International (Dubendorf, Switzerland). All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDAapproval status, of any drug or device prior to clinical use. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. Results With all surgeons pooled together, the interobserver agreement for fracture characteristics was substantial for assessment of a 2-mm articular step or gap (kappa, 0.73; 95% CI, 0.60-0.86; p \ 0.001), subluxation or dislocation (kappa, 0.72; 95% CI, 0.58-0.86; p \ 0.001), and percentage of articular surface involved (intraclass correlation coefficient [ICC], 0.67; 95% CI, 0.54-0.81; p \ 0.001); moderate for comminution (kappa, 0.55; 95% CI, 0.39-0.70; p \ 0.001) and stability (kappa, 0.54; 95% CI, 0.39-0.69; p \ 0.001); and fair for the number of fracture fragments (ICC, 0.39; 95% CI, 0.27-0.57; p \ 0.001). When recommending treatment, interobserver agreement was substantial (kappa, 0.69; 95% CI, 0.50-0.88; p \ 0.001)...

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Section: Discussionmentioning

confidence: 70%

Section: Introductionmentioning

confidence: 99%

What Middle Phalanx Base Fracture Characteristics are Most Reliable and Useful for Surgical Decision-making?

Janssen

Molleman

Guitton

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…However, in support of our methods, one study found that arthroscopic grade 3 and 4 lesions, which are most relevant with regard to the potential need for repair, corresponded with radiographic gaps of 3-5 and 5-6 mm, respectively, and thus would be detected by our study protocol [8]. Similarly, a recent multicenter study of interobserver reliability using standard PA and lateral radiographs to detect scapholunate dissociation, with CT arthrography and operative confirmation as the reference standard, found a negative predictive value of 98 %, and thus concluded that radiographs were reliable for ruling out dissociation [9]. Another option may have been stress radiographs or fluoroscopy to assess for dynamic instability.…”

Section: Limitationssupporting

confidence: 73%

Scapholunate Instability after Distal Radius Volar Plating

Jones

Everding

Desmarais

et al. 2015

Hand (New York, N,Y.)

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Background Prior to volar locked plating and early motion protocols, ligamentous injuries incidentally associated with distal radius fractures may have been indirectly treated with immobilization. Our goal was to determine the prevalence of scapholunate instability in our population, while identifying those who may have had progression of instability. Methods We retrospectively reviewed 221 distal radius fractures treated with a volar locking plate during a 6-year period. Average patient age was 59 years. Standard posteroanterior and lateral radiographs from the first and last postoperative visits were analyzed for scapholunate instability, using the criteria of scapholunate gap ≥3 mm and scapholunate angle ≥60°. Results Six patients (3 %) met neither or only one criterion for instability at the first postoperative visit and did not have ligament repair and then went on to meet both criteria at the last postoperative visit after an early motion protocol. Seven patients (3 %) met both criteria at the first and last postoperative visits and did not have ligament repair. Five patients (2 %) underwent primary scapholunate ligament repair at the time of distal radius fixation. Conclusions In our representative population, scapholunate instability was uncommon, either from initial injury or possible progression of occult ligament injury, despite early motion without operative treatment of the ligament. Thus, we did not find strong evidence for routinely delaying motion or pursuing further workup. When early radiographs clearly demonstrate acute scapholunate instability, more aggressive treatment may be appropriate for selected patients.

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“…The authors reported that radiographs are moderately reliable in diagnosing SLIL injuries in distal radius fractures and are better at ruling out these injuries than confirming their presence. 19 In a comparative study between advanced imaging and radiography, Suzuki and colleagues 20 reported that coronal CT scans were the most effective in diagnosing an arthroscopically confirmed SLIL injury using measurements of the scapholunate interval. They further discussed the limited interobserver reliability of plain radiographs in measuring the scapholunate interval and that the reliability and accuracy improved with the use of CT scans preoperatively.…”

Section: Introductionmentioning

confidence: 99%

“…19 High-resolution magnetic resonance imaging (MRI) is now the advanced imaging modality of choice for evaluating the SLIL in most centers. 23 Reliable and accurate MRI diagnosis depends on multiple factors, such as the imaging protocol, the radiologist's experience, and whether the tear is complete or incomplete.…”

Section: Introductionmentioning

confidence: 99%

Management of Intercarpal Ligament Injuries Associated with Distal Radius Fractures

2015

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Radiographic Diagnosis of Scapholunate Dissociation Among Intra-articular Fractures of the Distal Radius: Interobserver Reliability

Cited by 30 publications

References 17 publications

What Middle Phalanx Base Fracture Characteristics are Most Reliable and Useful for Surgical Decision-making?

What Middle Phalanx Base Fracture Characteristics are Most Reliable and Useful for Surgical Decision-making?

Scapholunate Instability after Distal Radius Volar Plating

Management of Intercarpal Ligament Injuries Associated with Distal Radius Fractures

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