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Davidson A, Feldman G, Mosheiff R, Suna A, Joskowicz L, Weil YA. Computer-Generated Radiographic Measurements of Distal Radius Fractures: Does It Help With Decision Making? J Hand Surg Am 2024; 49:796.e1-796.e7. [PMID: 36336570 DOI: 10.1016/j.jhsa.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 08/30/2022] [Accepted: 09/21/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Operative management of distal radius fractures (DRFs) has become increasingly common. Age, activity levels, and comorbid conditions are major factors influencing the treatment decision, although operative indications are still controversial. Radiographic parameters (RPs), such as radial inclination, dorsal tilt, and articular step-off, can provide objective support for effective decision making. However, manual measurement of RPs may be imprecise and subject to inconsistency. To address this problem, we developed custom software of an algorithm to automatically detect and compute 6 common RPs associated with DRF in anteroposterior and lateral radiographs. The aim in this study was to assess the effect of this software on radiographic interobserver variability among orthopedic surgeons. Our hypothesis was that precise and consistent measurement of RPs will improve radiographic interpretation variability among surgeons and, consequently, may aid in clinical decision making. METHODS Thirty-five radiograph series of DRFs were presented to 9 fellowship-trained hand and orthopedic trauma surgeons. Each case was presented with basic clinical information, together with plain anteroposterior and lateral radiographs. One of the 2 possible treatment options was selected: casting or open reduction with a locking plate. The survey was repeated 3 weeks later, this time with computer-generated RP measurements. Data were analyzed for interobserver and intraobserver variability for both surveys, and the interclass coefficient, kappa value, was calculated. RESULTS The interobserver reliability (interclass coefficient value) improved from poor to moderate, 0.35 to 0.50, with the provided RP. The average intraobserver interclass coefficient was 0.68. When participants were assessed separately according to their subspecialties (trauma and hand), improved interobserver variability was found as well. CONCLUSIONS Providing computed RPs to orthopedic surgeons may improve the consistency of the radiographic judgment and influence their clinical decision for the treatment of DRFs. CLINICAL RELEVANCE Orthopedic surgeons' consistency in the radiographic judgment of DRFs slightly improved by providing automatically calculated radiographic measurements to them.
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Affiliation(s)
- Amit Davidson
- Orthopaedic Department, Hadassah Hebrew University Hospital, Jerusalem, Israel; Orthopedic Department, Shaare Zedek Medical Center, Jerusalem, Israel.
| | - Guy Feldman
- Orthopaedic Department, Hadassah Hebrew University Hospital, Jerusalem, Israel; Orthopedic Department, Emek Medical Center, Afula, Israel
| | - Rami Mosheiff
- Orthopaedic Department, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Avigail Suna
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Leo Joskowicz
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yoram A Weil
- Orthopaedic Department, Hadassah Hebrew University Hospital, Jerusalem, Israel
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Suojärvi N, Waris E. Radiographic measurements in distal radius fracture evaluation: a review of current techniques and a recommendation for standardization. Acta Radiol 2024:2841851241266369. [PMID: 39043232 DOI: 10.1177/02841851241266369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
Radiographic measurements play a crucial role in evaluating the alignment of distal radius fractures (DRFs). Various manual methods have been used to perform the measurements, but they are susceptible to inaccuracies. Recently, computer-aided methods have become available. This review explores the methods commonly used to assess DRFs. The review introduces the different measurement techniques, discusses the sources of measurement errors and measurement reliability, and provides a recommendation for their use. Radiographic measurements used in the evaluation of DRFs are not reliable. Standardizing the measurement techniques is crucial to address this and automated image analysis could help improve accuracy and reliability.
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Affiliation(s)
- Nora Suojärvi
- Department of Hand Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eero Waris
- Department of Hand Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Esworthy GP, Shaji V, Duraku L, Wu F, Power DM. Bridge Plate Distraction for Complex Distal Radius Fractures: A Cohort Study and Systematic Review of the Literature. J Wrist Surg 2024; 13:282-292. [PMID: 38808186 PMCID: PMC11129887 DOI: 10.1055/s-0043-1770791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 05/22/2023] [Indexed: 05/30/2024]
Abstract
Background Dorsal bridge plating (DP) of the distal radius is used as a definitive method of stabilization in complex fracture configurations and polytrauma patients. Questions/Purposes This review aims to summarize the current understanding of DP and evaluate surgical outcomes. Methods Four databases were searched following the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines and registered with PROSPERO. Papers presenting outcome or complication data for DP were included. These were reviewed using the National Institutes of Health Quality Assessment and Methodological Index for Non-Randomised Studies tools. Results were collated and compared to a local cohort of DP patients. Results Literature review identified 416 patients with a pooled complication rate of 17% requiring additional intervention. The most prevalent complications were infection/wound healing issues, arthrosis, and hardware failure. Average range of motion was flexion 46.5 degrees, extension 50.7 degrees, ulnar deviation 21.4 degrees, radial deviation 17.3 degrees, pronation 75.8 degrees, and supination 72.9 degrees. On average, DP removal occurred at 3.8 months. Quality assessment showed varied results. There were 19 cases in our local cohort. Ten displayed similar results to the systematic review in terms of range of motion and radiographic parameters. Higher QuickDASH scores and complication rates were noted. Local DP showed earlier plate removal at 2.9 months compared to previous studies. Conclusion DP is a valid and useful technique for treating complex distal radius fractures. It displays a lower risk of infection and pain compared to external fixation which is commonly used to treat similar injuries. Patients can recover well following treatment both in function and range of motion. Further high-quality studies are required to fully evaluate the technique.
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Affiliation(s)
- George P. Esworthy
- Birmingham Hand Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Untied Kingdom
- Leicester Medical School, University of Leicester, Leicester, United Kingdom
| | - Vibha Shaji
- Leicester Medical School, University of Leicester, Leicester, United Kingdom
| | - Liron Duraku
- Birmingham Hand Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Untied Kingdom
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, Netherlands
| | - Feiran Wu
- Birmingham Hand Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Untied Kingdom
| | - Dominic M. Power
- Birmingham Hand Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Untied Kingdom
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Derksen BM, Jawahier PA, Wijers O, Knops SP, de Vries MR, van Hooff CCD, Verhofstad MHJ, Schep NWL. Refraining from closed reduction of displaced distal radius fractures in the emergency department-in short: the RECORDED trial. Trials 2024; 25:303. [PMID: 38711069 PMCID: PMC11075287 DOI: 10.1186/s13063-024-08118-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/16/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND With roughly 45,000 adult patients each year, distal radius fractures are one of the most common fractures in the emergency department. Approximately 60% of all these fractures are displaced and require surgery. The current guidelines advise to perform closed reduction of these fractures awaiting surgery, as it may lead to post-reduction pain relief and release tension of the surrounding neurovascular structures. Recent studies have shown that successful reduction does not warrant conservative treatment, while patients find it painful or even traumatizing. The aim of this study is to determine whether closed reduction can be safely abandoned in these patients. METHODS In this multicenter randomized clinical trial, we will randomize between closed reduction followed by plaster casting and only plaster casting. Patients aged 18 to 75 years, presenting at the emergency department with a displaced distal radial fracture and requiring surgery according to the attending surgeon, are eligible for inclusion. Primary outcome is pain assessed with daily VAS scores from the visit to the emergency department until surgery. Secondary outcomes are function assessed by PRWHE, length of stay at the emergency department, length of surgery, return to work, patient satisfaction, and complications. A total of 134 patients will be included in this study with follow-up of 1 year. DISCUSSION If our study shows that patients who did not receive closed reduction experience no significant drawbacks, we might be able to reorganize the initial care for distal radial fractures in the emergency department. If surgery is warranted, the patient can be sent home with a plaster cast to await the call for admission, decreasing the time spend in the emergency room drastically. TRIAL REGISTRATION This trial was registered on January 27, 2023.
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Affiliation(s)
- B M Derksen
- Department of Trauma Surgery, Maasstad Hospital, Rotterdam, the Netherlands.
| | - P A Jawahier
- Department of Trauma Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | - O Wijers
- Department of Trauma Surgery, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands
| | - S P Knops
- Department of Trauma Surgery, Ikazia Hospital, Rotterdam, the Netherlands
| | - M R de Vries
- Department of Trauma Surgery, IJsselland Hospital Rotterdam, Capelle Aan Den IJssel, the Netherlands
| | | | - M H J Verhofstad
- Department of Trauma Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - N W L Schep
- Department of Trauma Surgery, Maasstad Hospital, Rotterdam, the Netherlands
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Kramer SB, Lans J, Zamri M, Meulendijks MZ, He J, Lagasse V, Chen NC. Quantitative Analysis of the Volar Ulnar Corner of the Distal Radius: A Reference for Intraoperative Distal Radius Fracture Reduction. J Hand Surg Am 2023; 48:1158.e1-1158.e11. [PMID: 35641390 DOI: 10.1016/j.jhsa.2022.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/13/2022] [Accepted: 03/25/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The reduction of distal radius fractures using volar locking plate fixation can be performed by securing the plate to the distal fragments and then levering the plate to the radial shaft. Oblique placement of the plate on the radial shaft may lead to malreduction. The aim of this study was to evaluate parameters that can be used for the assessment of intraoperative distal radius fracture reduction using "distal-first" volar plate fixation, especially the geometry of the ulnar corner. The prevalence of Tolat distal radioulnar joint (DRUJ) types was determined, and the angles of the volar corner were quantitatively described. METHODS Three hundred seventy-five adult patients with a conventional wrist radiograph in their medical chart were identified. From this cohort, 50 radiographs of each Tolat DRUJ type were quantitatively analyzed using 4 angles. The probability density of each angle was described using Kernel density estimation graphs. A multivariable analysis was used to study the association between the 4 angles and Tolat DRUJ types and other patient factors. RESULTS One hundred fifty-one patients (40%) had a wrist with type 1 DRUJ, 147 (39%) had a wrist with type 2 DRUJ, and 77 (21%) had a wrist with type 3 DRUJ. The measurements of the distal ulnar corner, volar ulnar corner, and DRUJ angulation were significantly different among each Tolat DRUJ type. The median lunate facet inclination, relative to the axis of the radial shaft, measured 14° (interquartile range, 12°-16°) across all the Tolat DRUJ types. CONCLUSIONS The prevalence of Tolat type 1, 2, and 3 DRUJ was 40%, 39%, and 21%, respectively. The angles of the volar ulnar corner varied with each DRUJ type. CLINICAL RELEVANCE Because the lunate facet inclination was relatively consistent among all the Tolat DRUJ types, this angle may be useful as a reference for "distal-first" distal radius volar plating.
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Affiliation(s)
- Simon B Kramer
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA
| | - Jonathan Lans
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA
| | - Meryam Zamri
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA
| | - Mara Z Meulendijks
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA
| | - Janice He
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA
| | - Victoria Lagasse
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA
| | - Neal C Chen
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA.
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Esworthy G, Johnson N, Group DRM, Dias J. Reliability and reproducibility of methods for measurement of distal radius fracture intra-articular displacement. J Hand Surg Eur Vol 2023; 48:1087-1089. [PMID: 37211795 DOI: 10.1177/17531934231173248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
| | - Nick Johnson
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
- Pulvertaft Hand Centre, University Hospitals of Derby and Burton NHS Trust, Derby, UK
| | | | - Joseph Dias
- Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
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Wieschollek S, Knie C, Megerle K. Cone-beam computed tomography in the treatment of distal radius fractures. HANDCHIR MIKROCHIR P 2023; 55:174-185. [PMID: 37307810 DOI: 10.1055/a-2055-2591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
Cone-beam computed tomography (CBCT) is a relatively new imaging technique in hand surgery. Being the most common fractures in adults, distal radius fractures are of special importance not only to hand surgeons. The quantity alone calls for fast, efficient and reliable diagnostic procedures. Surgical techniques and possibilities are progressing, especially regarding intra-articular fracture patterns. The demand for exact anatomic reduction is high. There is an overall consensus regarding the indication for preoperative three-dimensional imaging and it is frequently used. Typically, it is obtained by multi-detector computed tomography (MDCT). Postoperative diagnostic procedures are usually limited to plain x-rays. Commonly accepted recommendations regarding postoperative 3D imaging are not yet established. There is a lack of relevant literature. In case of an indication for a postoperative CT scan, it is generally also obtained by MDCT. CBCT for the wrist is not widely used as yet. This review focuses on the potential role of CBCT in the perioperative management of distal radius fractures. CBCT allows for high-resolution imaging with a potentially lower radiation dose compared with MDCT, both with and without implants. It is easily available and can be operated independently, thus being time-efficient and making daily practice easier. Due to its many advantages, CBCT is a recommendable alternative to MDCT in the perioperative management of distal radius fractures.
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Affiliation(s)
- Stefanie Wieschollek
- Zentrum für Handchirurgie, Mikrochirurgie und plastische Chirurgie, Schön Klinik München Harlaching, München, Germany
| | - Careen Knie
- Zentrum für Handchirurgie, Mikrochirurgie und plastische Chirurgie, Schön Klinik München Harlaching, München, Germany
| | - Kai Megerle
- Zentrum für Handchirurgie, Mikrochirurgie und plastische Chirurgie, Schön Klinik München Harlaching, München, Germany
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8
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Kramer SB, Selles CA, Bakker D, Schep NWL. Comparison of extra-articular radiographic parameters of distal radius fractures on plain radiographs and CT scans. J Hand Surg Eur Vol 2022; 47:142-149. [PMID: 34092134 DOI: 10.1177/17531934211021042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of this study was to compare extra-articular radiographic parameters of distal radial fractures measured on plain radiographs and CT scans. Two researchers independently measured four extra-articular radiographic parameters (dorsal tilt, carpal alignment, radial inclination and ulnar variance) on both radiographs and CT scans in 85 patients. Inter-observer reliability for both techniques was assessed, along with the agreement between CT scans and radiographs using the intraclass correlation coefficient and Bland-Altman plots. The results showed that dorsal tilt, carpal alignment, radial inclination and ulnar variance can be measured reliably on both radiographs and CT scans. At a patient level, carpal alignment, radial inclination and ulnar variance CT scan measurements are an acceptable alternative to plain radiograph measurements in the vast majority of patients. In contrast, dorsal tilt CT scan measurements are not comparable with radiographs in 40% of the cases. Therefore, caution should be taken in measuring dorsal tilt on CT scans.
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Affiliation(s)
- Simon B Kramer
- Department of Trauma Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - Caroline A Selles
- Department of Trauma Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - Daniel Bakker
- Department of Trauma Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - Niels W L Schep
- Department of Trauma Surgery, Maasstad Hospital, Rotterdam, The Netherlands
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9
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Fitzpatrick E, Sharma V, Rojoa D, Raheman F, Singh H. The use of cone-beam computed tomography (CBCT) in radiocarpal fractures: a diagnostic test accuracy meta-analysis. Skeletal Radiol 2022; 51:923-934. [PMID: 34542681 PMCID: PMC8930799 DOI: 10.1007/s00256-021-03883-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/25/2021] [Accepted: 07/25/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Occult radiocarpal fractures often present a diagnostic challenge to the emergency department. Accurate diagnosis of these injuries is crucial as a missed fracture can lead to significant morbidity. Cone-beam CT (CBCT) scan is a novel imaging modality, with minimal radiation exposure and comparatively fast acquisition time. Our aim was to evaluate its use in the diagnosis of cortical fractures in the upper limb extremity. MATERIALS AND METHODS We conducted a systematic review of literature and included all studies that evaluated the use of CBCT in the diagnosis of radiocarpal fractures. We used a mixed-effects logistic regression bivariate model to estimate the summary sensitivity and specificity and constructed hierarchical summary receiver operative characteristic curves (HSROC). RESULTS We identified 5 studies, with 439 patients, and observed CBCT to be 87.7% (95% CI 77.6-93.6) sensitive and 99.2% (95% CI 92.6-99.9) specific for scaphoid fractures. For carpal fractures, CBCT was observed to have a pooled sensitivity and specificity of 90.6% (95% CI 72.7-97.2) and 100% (95% CI 99-100) respectively. For distal radius fractures, CBCT sensitivity was 90% (95% CI 67-98) and specificity was 100% (95% CI 10-100). The overall inter-rater agreement effect was shown to be 0.89 (95% CI 0.82-0.96), which is deemed to be almost perfect. CONCLUSION CBCT is an accurate diagnostic tool for occult radiocarpal cortical fractures, which could replace or supplement radiographs. We believe CBCT has a promising role in the acute radiocarpal fracture diagnostic algorithm in both emergency and trauma departments.
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Affiliation(s)
- Emma Fitzpatrick
- Department of Trauma and Orthopaedics, Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK
| | - Vivek Sharma
- Department of Trauma and Orthopaedics, Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK
| | - Djamila Rojoa
- Department of Plastics Surgery, Leicester Royal Infirmary, University Hospital of Leicester, Leicester, UK
| | - Firas Raheman
- Department of Trauma and Orthopaedics, Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK
| | - Harvinder Singh
- Department of Trauma and Orthopaedics, Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK
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10
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Koivisto J, van Eijnatten M, Ludlow J, Kiljunen T, Shi X, Wolff J. Comparative dosimetry of radiography device, MSCT device and two CBCT devices in the elbow region. J Appl Clin Med Phys 2021; 22:128-138. [PMID: 33811787 PMCID: PMC8130242 DOI: 10.1002/acm2.13245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/09/2021] [Accepted: 03/17/2021] [Indexed: 12/27/2022] Open
Abstract
The aim of the study was to estimate and to compare effective doses in the elbow region resulting from four different x-ray imaging modalities. Absorbed organ doses were measured using 11 metal oxide field effect transistor (MOSFET) dosimeters that were placed in a custom-made anthropomorphic elbow RANDO phantom. Examinations were performed using Shimadzu FH-21 HR radiography device, Siemens Sensation Open 24-slice MSCT-device, NewTom 5G CBCT device, and Planmed Verity CBCT device, and the effective doses were calculated according to ICRP 103 recommendations. The effective dose for the conventional radiographic device was 1.5 µSv. The effective dose for the NewTom 5G CBCT ranged between 2.0 and 6.7 µSv, for the Planmed Verity CBCT device 2.6 µSv and for the Siemens Sensation MSCT device 37.4 µSv. Compared with conventional 2D radiography, this study demonstrated a 1.4-4.6 fold increase in effective dose for CBCT and 25-fold dose for standard MSCT protocols. When compared with 3D CBCT protocols, the study showed a 6-19 fold increase in effective dose using a standard MSCT protocol. CBCT devices offer a feasible low-dose alternative for elbow 3D imaging when compared to MSCT.
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Affiliation(s)
- Juha Koivisto
- Department of PhysicsUniversity of HelsinkiHelsinkiFinland
| | - Maureen van Eijnatten
- Department of Oral and Maxillofacial Surgery/Oral PathologyVU University Medical CenterAmsterdamThe Netherlands
| | - John Ludlow
- University of North CarolinaAdams School of DentistryChapel HillNCUSA
| | | | - Xie‐Qi Shi
- Section of Oral Maxillofacial RadiologyDepartment of Clinical DentistryFaculty of Medicine and DentistryUniversity of BergenBergenNorway
| | - Jan Wolff
- Department of Oral Maxillofacial SurgeryUniversity Medical Center Hamburg‐EppendorfHamburgGermany
- Division of Regenerative Orofacial MedicineHamburgGermany
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11
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Suojärvi N, Lindfors N, Höglund T, Sippo R, Waris E. Radiographic measurements of the normal distal radius: reliability of computer-aided CT versus physicians' radiograph interpretation. J Hand Surg Eur Vol 2021; 46:176-183. [PMID: 33148107 DOI: 10.1177/1753193420968399] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We examined the reliability of a computer-aided cone-beam CT analysis of radiographic parameters of 50 normal distal radii and compared it with interobserver agreement of measurements made by three groups of physicians on two-dimensional plain radiographs. The intra-rater reliability of the computer-aided analysis was evaluated on 33 wrists imaged twice by cone-beam CT. The longitudinal axis, anterior tilt, radial inclination and ulnar variance were measured. The reliability of computer-aided analysis was excellent (intraclass correlation coefficient (ICC) 0.94-0.96) while the interobserver agreement of two-dimensional radiograph interpretation was good (ulnar variance, ICC 0.80-0.84) to poor (anterior tilt and radial inclination, ICC 0.20-0.42). We conclude that computer-aided cone-beam CT analysis was a reliable tool for radiographic parameter determination, whereas physicians demonstrated substantial variability especially in interpreting the angular parameters.
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Affiliation(s)
- Nora Suojärvi
- Department of Hand Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Nina Lindfors
- Department of Hand Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Robert Sippo
- Department of Hand Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Eero Waris
- Department of Hand Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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12
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Pallaver A, Honigmann P. The Role of Cone-Beam Computed Tomography (CBCT) Scan for Detection and Follow-Up of Traumatic Wrist Pathologies. J Hand Surg Am 2019; 44:1081-1087. [PMID: 31610905 DOI: 10.1016/j.jhsa.2019.07.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/20/2019] [Accepted: 07/25/2019] [Indexed: 02/02/2023]
Abstract
Emergency diagnostics demand fast, easily available, and cost-effective procedures. The higher the accuracy of radiological imaging, the better it supports the surgeon in decision-making for further treatment. Cone-beam computed tomography has been proven to be a reliable tool in diagnosing fractures of the hand and distal forearm. It can be easily installed, has a high spatial resolution, and a potentially lower radiation dose when compared with multislice computed tomography or a series of plain x-rays. This review focuses on the value of conventional radiography, cone-beam computed tomography, and multislice computed tomography for diagnosing traumatic wrist pathologies.
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Affiliation(s)
- Armin Pallaver
- Hand Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Philipp Honigmann
- Hand Surgery, Kantonsspital Baselland, Liestal, Switzerland; Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, Basel, Switzerland.
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13
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Azi ML, Teixeira MB, de Carvalho SF, de Almeida Teixeira AA, Cotias RB. Computed Tomography vs Standard Radiograph in Preoperative Planning of Distal Radius Fractures with Articular Involvement. Strategies Trauma Limb Reconstr 2019; 14:15-19. [PMID: 32559262 PMCID: PMC7001594 DOI: 10.5005/jp-journals-10080-1420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction Distal radius fractures with articular involvement are more likely to require surgical management. Treatment decisions are based on parameters which are obtained from plain radiographs. This study aims to determine the differences between computed tomography and standard radiographs in the preoperative planning of distal radius fractures with articular involvement. This was performed by measuring the intraobserver and interobserver reliability between three systems used to interpret the main fracture characteristics and two treatment decisions. Materials and methods Forty-three cases of distal radius fractures with articular involvement were included. Fracture displacement was measured using plain radiographic and computed tomography. Five orthopedic surgeons evaluate the images to determine the AO/OTA classification, the articular fragments, the biomechanical columns involved, and recommend a surgical approach and implant for fracture fixation. Results An articular step-off was identified in 13 cases (30%) with the standard radiographs and in 22 (51%) cases with the computed tomography (p = 0.00). Interobserver variation for preoperative planning was slight when evaluated using the standard radiographs. Computed tomography improves reliability for AO/OTA classification and articular fragments but not for the biomechanical columns. Intraobserver variation for preoperative planning was slight to moderate for AO/OTA classification and slight to fair for identification of articular fragments and biomechanical columns. With regard to selection of the surgical approach, there was slight to moderate variation and, finally, for fracture fixation it was slight to fair. Conclusion Information provided by conventional radiography and computed tomography are sufficiently different as to induce the surgeon to select different treatments for the same fracture. How to cite this article Azi ML, Teixeira MB, de Carvalho SF, et al. Computed Tomography vs Standard Radiograph in Preoperative Planning of Distal Radius Fractures with Articular Involvement. Strategies Trauma Limb Reconstr 2019;14(1):15–19.
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Affiliation(s)
- Matheus L Azi
- Department of Orthopaedic Trauma, Manoel Victorino Hospital, Salvador, Bahia, Brazil
| | - Marcelo B Teixeira
- Department of Orthopaedic Trauma, Suburbio Hospital, Secretary of Health for the State of Bahia, Salvador, Bahia, Brazil
| | - Suedson F de Carvalho
- Department of Orthopaedic Trauma, Suburbio Hospital, Secretary of Health for the State of Bahia, Salvador, Bahia, Brazil
| | - Armando A de Almeida Teixeira
- Department of Orthopaedic Trauma, Suburbio Hospital, Secretary of Health for the State of Bahia, Salvador, Bahia, Brazil
| | - Ricardo B Cotias
- Department of Orthopaedic Trauma, Suburbio Hospital, Secretary of Health for the State of Bahia, Salvador, Bahia, Brazil
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Koivisto J, van Eijnatten M, Kiljunen T, Shi XQ, Wolff J. Effective Radiation Dose in the Wrist Resulting from a Radiographic Device, Two CBCT Devices and One MSCT Device: A Comparative Study. RADIATION PROTECTION DOSIMETRY 2018; 179:58-68. [PMID: 29040707 DOI: 10.1093/rpd/ncx210] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 09/19/2017] [Indexed: 06/07/2023]
Abstract
The objective of the present study was to assess and compare the effective doses in the wrist region resulting from conventional radiography device, multislice computed tomography (MSCT) device and two cone beam computed tomography (CBCT) devices using MOSFET dosemeters and a custom made anthropomorphic RANDO phantom according to the ICRP 103 recommendation. The effective dose for the conventional radiography was 1.0 μSv. The effective doses for the NewTom 5 G CBCT ranged between 0.7 μSv and 1.6 μSv, for the Planmed Verity CBCT 2.4 μSv and for the MSCT 8.6 μSv. When compared with the effective dose for AP- and LAT projections of a conventional radiographic device, this study showed an 8.6-fold effective dose for standard MSCT protocol and between 0.7 and 2.4-fold effective dose for standard CBCT protocols. When compared to the MSCT device, the CBCT devices offer a 3D view of the wrist at significantly lower effective doses.
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Affiliation(s)
- Juha Koivisto
- Department of Oral and Maxillofacial Surgery, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Maureen van Eijnatten
- Department of Oral and Maxillofacial Surgery, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Timo Kiljunen
- International Docrates Cancer Center, Helsinki, Finland; Saukonpaadenranta 2, FI-00180, Helsinki, Finland
| | - Xie-Qi Shi
- Section of Oral Maxillofacial Radiology, Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Årstadveien 19, 5009 Bergen, Norway
- Sektionen för bild- och funktionsfysik, C2-63Karolinska Universitetssjukhuset, Huddinge, SE-141 86 Stockholm, Sweden
| | - Jan Wolff
- Department of Oral and Maxillofacial Surgery, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
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Osgood GM, Thawait GK, Hafezi-Nejad N, Shakoor D, Shaner A, Yorkston J, Zbijewski WB, Siewerdsen JH, Demehri S. Image quality of cone beam computed tomography for evaluation of extremity fractures in the presence of metal hardware: visual grading characteristics analysis. Br J Radiol 2017; 90:20160539. [PMID: 28281784 DOI: 10.1259/bjr.20160539] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate image quality and interobserver reliability of a novel cone-beam CT (CBCT) scanner in comparison with plain radiography for assessment of fracture healing in the presence of metal hardware. METHODS In this prospective institutional review board-approved Health Insurance Portability and Accountability Act of 1996-complaint study, written informed consent was obtained from 27 patients (10 females and 17 males; mean age 44 years, age range 21-83 years) with either upper or lower extremity fractures, and with metal hardware, who underwent CBCT scans and had a clinical radiograph of the affected part. Images were assessed by two independent observers for quality and interobserver reliability for seven visualization tasks. Visual grading characteristic (VGC) curve analysis determined the differences in image quality between CBCT and plain radiography. Interobserver agreement was calculated using Pearson's correlation coefficient. RESULTS VGC results displayed preference of CBCT images to plain radiographs in terms of visualizing (1) cortical and (2) trabecular bones; (3) fracture line; (4) callus formation; (5) bridging ossification; and (6) screw thread-bone interface and its inferiority to plain radiograph in the visualization of (7) large metallic side plate contour with strong interobserver correlation (p-value < 0.05), except for visualizing large metallic side plate contour. CONCLUSION For evaluation of fracture healing in the presence of metal hardware, CBCT image quality is preferable to plain radiograph for all visualization tasks, except for large metallic side plate contours. Advances in knowledge: CBCT has the potential to be a good diagnostic alternative to plain radiographs in evaluation of fracture healing in the presence of metal hardware.
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Affiliation(s)
- Greg M Osgood
- 1 Department of Orthopedics, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Gaurav K Thawait
- 2 Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Nima Hafezi-Nejad
- 2 Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Delaram Shakoor
- 2 Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Adam Shaner
- 1 Department of Orthopedics, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Wojciech B Zbijewski
- 4 Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Jeffrey H Siewerdsen
- 4 Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Shadpour Demehri
- 2 Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
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