Radiographic evaluation of osseous displacement following intra-articular fractures of the distal radius: Reliability of plain radiography versus computed tomography

Cole, Roger J.; Bindra, Ranjna; Evanoff, Bradley; Gilula, Louis A.; Yamaguchi, K; Gelberman, Richard H.

doi:10.1016/s0363-5023(97)80071-8

Cited by 213 publications

(44 citation statements)

References 22 publications

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“…Although radiography was standardised, it is well recognised that rotation of the forearm, which could occur, may affect these parameters with pronation of 10º decreasing the apparent VT, RL and RI by 4.4º, 1.6mm and 2.8º respectively 12 . There is consequently an argument for computed tomography assessment over plain radiography since it is more reliable for quantifying displacement 13 . Unfortunately, our retrospective design did not allow for computed tomography in the present study.…”

Section: Discussionmentioning

confidence: 90%

Does the DVR^® plate restore bony anatomy following distal radius fractures?

Patel

Menéndez

Hossain

et al. 2014

annals

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INTRODUCTIONFractures of the distal radius are common. Malreduced fractures are associated with residual functional deficiency. There has been a trend over the last few years for using fixed angle volar locking plates to surgically stabilise this injury. Our unit uses the DVR® plate (DePuy, Warsaw, IN, US). Nevertheless, it is unknown whether the normal bony anatomy is recreated or merely restored to acceptable limits with its usage. The aim of this study was to evaluate the reduction achieved compared with an uninjured population and pre-existing quoted ‘normal’ values. Furthermore, we wanted to identify the percentage of cases that were reduced to acceptable limits, and determine whether the grade of the surgeon and fracture type was a confounding influence on this reduction.METHODSA retrospective review of the 3-month postoperative radiography of 48 eligible patients who underwent open reduction and internal fixation of a distal radius fracture with a DVR® plate was undertaken.RESULTSVolar tilt, radial length and inclination were different to quoted normal values (p<0.01). Despite this, these parameters fell within acceptable limits in 46 cases; this was not influenced by fracture type or grade of operating surgeon.CONCLUSIONSThe DVR® plate restores the bony anatomy to within acceptable limits in the majority of patients who have sustained a fracture of the distal radius although of all parameters investigated, the widest variability is seen in volar tilt.

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Section: Discussionmentioning

confidence: 90%

Does the DVR^® plate restore bony anatomy following distal radius fractures?

Patel

Menéndez

Hossain

et al. 2014

annals

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“…Although the previous literature showed that CT scans are more reliable than X-rays quantifying articular surface incongruencies [7–10, 13], to the best of our knowledge no previous studies have reported whether the usefulness of an additional CT scan is predictable.…”

Section: Discussionmentioning

confidence: 99%

“…This increased popularity is supported by the previous literature. CT scans have been shown to be more reliable than X-rays in quantifying articular surface incongruencies [6–10]. Furthermore, when a treatment plan is based on both X-ray and CT scan, a surgeon is more likely to treat the DRF patient surgically than when the treatment plan is based on X-ray alone [11].…”

Section: Introductionmentioning

confidence: 99%

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

Kleinlugtenbelt

Madden

Groen

et al. 2017

Strategies in Trauma and Limb Reconstruction

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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.

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“…Computed tomography (CT), however, has been shown to perform superior to radiography for diagnosis of these fractures. Accordingly CT has been found to have a higher sensitivity for fractures of the carpus [3,4] and to be more accurate in evaluation of displacement and joint involvement for fractures of the distal radius [5–7]. The main drawback of CT is the higher amount of radiation.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Diagnostic Accuracy of Radiation Dose-Equivalent Radiography, Multidetector Computed Tomography and Cone Beam Computed Tomography for Fractures of Adult Cadaveric Wrists

et al. 2016

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PurposeTo compare the diagnostic accuracy of radiography, to radiography equivalent dose multidetector computed tomography (RED-MDCT) and to radiography equivalent dose cone beam computed tomography (RED-CBCT) for wrist fractures.MethodsAs study subjects we obtained 10 cadaveric human hands from body donors. Distal radius, distal ulna and carpal bones (n = 100) were artificially fractured in random order in a controlled experimental setting. We performed radiation dose equivalent radiography (settings as in standard clinical care), RED-MDCT in a 320 row MDCT with single shot mode and RED-CBCT in a device dedicated to musculoskeletal imaging. Three raters independently evaluated the resulting images for fractures and the level of confidence for each finding. Gold standard was evaluated by consensus reading of a high-dose MDCT.ResultsPooled sensitivity was higher in RED-MDCT with 0.89 and RED-MDCT with 0.81 compared to radiography with 0.54 (P = < .004). No significant differences were detected concerning the modalities’ specificities (with values between P = .98). Raters' confidence was higher in RED-MDCT and RED-CBCT compared to radiography (P < .001).ConclusionThe diagnostic accuracy of RED-MDCT and RED-CBCT for wrist fractures proved to be similar and in some parts even higher compared to radiography. Readers are more confident in their reporting with the cross sectional modalities. Dose equivalent cross sectional computed tomography of the wrist could replace plain radiography for fracture diagnosis in the long run.

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Radiographic evaluation of osseous displacement following intra-articular fractures of the distal radius: Reliability of plain radiography versus computed tomography

Cited by 213 publications

References 22 publications

Does the DVR^® plate restore bony anatomy following distal radius fractures?

Does the DVR^® plate restore bony anatomy following distal radius fractures?

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

Comparison of Diagnostic Accuracy of Radiation Dose-Equivalent Radiography, Multidetector Computed Tomography and Cone Beam Computed Tomography for Fractures of Adult Cadaveric Wrists

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Radiographic evaluation of osseous displacement following intra-articular fractures of the distal radius: Reliability of plain radiography versus computed tomography

Cited by 213 publications

References 22 publications

Does the DVR® plate restore bony anatomy following distal radius fractures?

Does the DVR® plate restore bony anatomy following distal radius fractures?

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

Comparison of Diagnostic Accuracy of Radiation Dose-Equivalent Radiography, Multidetector Computed Tomography and Cone Beam Computed Tomography for Fractures of Adult Cadaveric Wrists

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Does the DVR^® plate restore bony anatomy following distal radius fractures?

Does the DVR^® plate restore bony anatomy following distal radius fractures?