Radiographic measurements of the normal distal radius: reliability of computer-aided CT versus physicians’ radiograph interpretation

Suojärvi, Nora; Lindfors, Nina; Höglund, Theresa; Sippo, Robert; Waris, Eero

doi:10.1177/1753193420968399

Cited by 14 publications

(17 citation statements)

References 25 publications

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“…Recently high inter- and intra-observer agreement (ICC values 0.86–0.99) was documented in measurements of carpal angles made manually both on 3-D CT images and plain radiographs by experienced clinicians following printed instructions (Lee et al., 2018), which represents an optimal scenario for manual measurements. However, in reality, physicians making clinical radiographic measurements may often show higher individual variability (Suojärvi et al., 2021a). Carpal alignment measurements in radiographs are difficult to reproduce even for experienced viewers (Garcia-Elias et al., 1989; Larsen et al., 1991b; Nakamura et al., 1989).…”

Section: Discussionmentioning

confidence: 99%

Computer-based three-dimensional measurement of carpal alignment: measurement techniques and normal ranges

Sippo

Höglund

Waris

2021

J Hand Surg Eur Vol

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The three-dimensional carpal alignment was measured in the neutral wrist position in 121 asymptomatic volunteers using computer-based cone-beam CT analysis. Normal values and the reliability of the automated analysis are reported. An analysis software based on segmentation of CT images and mathematical modelling was used to determine several axis variants based on different landmarks and to calculate the intercarpal angles automatically. Twenty wrists were imaged twice to determine intra-observer reliability. Mean values using the preferred axis variants were: scapholunate angle 57° (SD 9°), radiolunate angle 2° (SD 10°), lunocapitate angle –14° (SD 9°). Using alternate axis variants notably changed the angles produced. The intra-observer reliability of the analysis was excellent (mean intraclass correlation coefficient 0.97, SD 0.03). Computer-based CT analysis enables highly reproducible and automated assessment of carpal alignment. This study provides a reference database for measurement techniques and normal carpal angle values in three-dimensional imaging.

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Section: Discussionmentioning

confidence: 99%

Computer-based three-dimensional measurement of carpal alignment: measurement techniques and normal ranges

Sippo

Höglund

Waris

2021

J Hand Surg Eur Vol

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“…Surgery for distal radius fractures requires anatomical realignment [ 19 ]. Although radiological parameters, such as RI, VT, and UV, of the contralateral side are generally used as indicators of anatomical reduction, the inter-rater reliability of these parameters is not high [ 20 , 21 ]. Furthermore, plain radiographs may yield inconsistent measurements depending on the incidence angle of X-rays and limb position because the articular surface of the distal radius is a complex 3D structure.…”

Section: Discussionmentioning

confidence: 99%

Computer-Aided Assessment of Three-Dimensional Standard Bone Morphology of the Distal Radius

et al. 2022

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The present study attempted to define the three-dimensional (3D) locations of reference points and standard measures of the distal radius of a normal wrist joint. One hundred wrists from 50 males and 50 females who matched the age distribution (19–95 years old, mean: 56.0 years old) were evaluated. Computed tomography (CT) images of normal wrist joints acquired for comparison with the affected side were used. The absence of a previous history and complaints in the unaffected wrist was confirmed in an interview and with medical records. Three-dimensional images of the distal radius were reconstructed using the data obtained from CT scans. The site at which the major axis of the radial diaphysis contacted the distal radius joint surface was defined as the origin. The 3D coordinates of reference points for the radial styloid process (1), sigmoid notch volar edge (2), and sigmoid notch dorsal edge (3) as well as the barycenter for the joint surface and joint surface area were evaluated. A slope of the line connecting coordinates 1–2 in the coronal plane was evaluated as the 3D radial inclination (3DRI) and that connecting coordinates 2–3 in the sagittal plane as the 3D palmar tilt (3DPT). Each measurement value was compared between males and females. The positions of each reference point from the origin were as follows: (1) 14.2 ± 1.3/12.6 ± 1.1 mm for the distal-palmar-radial position; (2) 19.3 ± 1.3/16.9 ± 1.3 mm for the proximal-palmar-ulnar position; (3) 15.6 ± 1.4/14.1 ± 0.9 mm for the proximal-dorsal-ulnar position; and (barycenter) 4.1 ± 0.7/3.7 ± 0.7 mm for the proximal-volar-ulnar position for males and females, respectively. The areas of the radius articular surface were 429.0 ± 67.9/347.6 ± 44.6 mm2 for males and females, respectively. The 3DRI and 3DPT were 24.2 ± 4.0/25.7 ± 3.1° and 10.9 ± 5.1/13.2 ± 4.4° for males and females, respectively. Significant differences were observed in all measurement values between males and females (P < 0.01). The reference points and measured values obtained in the present study will serve as criteria for identifying the dislocation direction and reduction conditions of distal radius fractures in 3D images.

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“…We appreciate the work undertaken by the authors in demonstrating the challenge of measuring the radiographic parameters of the distal radius in the 3-D imaging modality. Computer-aided analysis may offer an automated diagnostic aid in this (Suoja ¨rvi et al, 2021b).…”

Section: Ross Davidson* Maria Medeiros and Rachel Kwokmentioning

confidence: 99%

Re: Kramer et al. Comparison of extra-articular radiographic parameters of distal radius fractures on plain radiographs and CT scans. J Hand Surg Eur. 2022, 47: 142–9.

Waris

Suojärvi

2021

J Hand Surg Eur Vol

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We read this article with great interest. We commend the authors for undertaking an important comparison of the impact of Colles' versus scaphoid casts on hand function. This article provides a valuable contribution to the literature, however we have some questions regarding the methodology.The authors use the Jebsen-Taylor Hand Function Test (JHFT) to compare hand function between the Colles' and scaphoid cast types. Sears and Chung (2010) found that JHFT times poorly correlate with patient perception of hand functioning. For many patients, the time required to complete an activity is of little relevance; the ability to perform an action at all is the primary concern. The authors concluded that the JHFT should not be used alone to assess a patient's ability to perform activities of daily living. We kindly ask whether the authors considered alternative scoring approaches. The Michigan Hand Outcome Questionnaire (MHQ) assesses overall hand function in addition to other parameters, including patient-reported satisfaction and pain scores. While this study consisted of healthy volunteers, this scoring system may better reflect the day-today functioning of patients following a scaphoid fracture.We commend the authors for utilizing additional measures of hand function to better reflect the requirements of modern-day activities, however most smartphone devices have the option of reducing the need for manual typing via the use of voice notes. Did the authors consider arguably more crucial assessments, including the ability to turn a key or use cutlery? Additionally, subjects may improve their ability and speed in carrying out tasks with repeated attempts. We wonder whether the authors could disclose the order in which casting was performed. A more frequent application of the Colles' cast after the scaphoid cast could introduce bias to the results obtained.The authors only performed post-hoc analysis on results that were statistically significant and chose to not perform any testing on the negative findings from subsets 9-11. We kindly ask the authors to disclose the reason for this omission. Additionally, it is generally not advised to estimate power following study completion (Griffith and Feyman, 2021), and we ask the authors whether they considered alternative types of post-hoc test.Overall, this article answers an important research question, however caution should be taken regarding the conclusions drawn due to the questionable validity of the JHFT. Clarification of methodology, including the order of casting, and the application of post-hoc testing to negative findings may strengthen the study.

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Radiographic measurements of the normal distal radius: reliability of computer-aided CT versus physicians’ radiograph interpretation

Cited by 14 publications

References 25 publications

Computer-based three-dimensional measurement of carpal alignment: measurement techniques and normal ranges

Computer-based three-dimensional measurement of carpal alignment: measurement techniques and normal ranges

Computer-Aided Assessment of Three-Dimensional Standard Bone Morphology of the Distal Radius

Re: Kramer et al. Comparison of extra-articular radiographic parameters of distal radius fractures on plain radiographs and CT scans. J Hand Surg Eur. 2022, 47: 142–9.

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