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Zeng SL, Grier AJ, Langdell HC, Blevins KM, Tian WM, French RJ, Mithani SK, Hammert WC, Klifto CS. Comparison of Low-Dose Computed Tomography Versus Conventional-Dose Computed Tomography in the Evaluation of Distal Radius Fractures. Hand (N Y) 2024:15589447241232016. [PMID: 38450618 DOI: 10.1177/15589447241232016] [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: 03/08/2024]
Abstract
BACKGROUND Distal radius fractures (DRFs) are common upper extremity fractures and often require surgical fixation when they are intraarticular. Preoperative computed tomography (CT) has emerged as a surgical planning tool to evaluate intraarticular DRFs. Although CT affords additional details, patients receive higher radiation doses than standard radiographs. We aim to develop a low-dose CT (LDCT) protocol, relative to the institutional standard-dose CT wrist for intraarticular DRFs although providing adequate detail for surgical decision-making. METHODS A single-institution prospective study was conducted on patients with intraarticular DRFs who underwent closed reduction and below-elbow splinting who otherwise would undergo wrist CT. Observations were defined as total measurements taken, with each view undergoing 44 measurements. Patients underwent 2 scans with a standard dose and a 10× dose reduction. Articular step and gap measurements were recorded in the sagittal and coronal images. RESULTS A total of 11 patients were enrolled (7 women and 4 men). The mean age was 55 years (SD = 20.1). There were a total of 4 reviewers: 1 attending surgeon, 2 resident physicians, and 1 student. When comparing LDCT and conventional-dose CT (CDCT), there were no significant differences in step and gap measurements across all reviewers. CONCLUSION This study demonstrated that LDCT provides comparable imaging quality for surgical planning as a CDCT without significant diagnostic decay in the setting of DRFs. This comes with the added benefit of a 10-fold reduction in radiation exposure. These results suggest that LDCT is an opportunity to reduce effective radiation in patients although providing beneficial preoperative imaging.
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Affiliation(s)
| | - A Jordan Grier
- Department of Orthopedic Surgery, Duke University, Durham, NC, USA
| | - Hannah C Langdell
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, USA
| | - Kier M Blevins
- Department of Orthopedic Surgery, Duke University, Durham, NC, USA
| | | | | | - Suhail K Mithani
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, USA
| | - Warren C Hammert
- Department of Orthopedic Surgery, Duke University, Durham, NC, USA
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Haydel AL, Roubion RC, Graphia CT, Cloud CE, Leonardi C, Marrero CE. Preoperative Computed Tomography Scan in Distal Radius Fractures and the Effect on Preoperative Planning. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:141-145. [PMID: 38903840 PMCID: PMC11185880 DOI: 10.1016/j.jhsg.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 10/28/2023] [Indexed: 06/22/2024] Open
Abstract
Purpose It is unclear whether computed tomography (CT) scans alter the surgical plan when ordered before surgery for fixation of intra-articular distal radius fractures (DRFs). The purpose of this study was to determine whether a preoperative CT scan alters the planned approach (PA) or planned fixation strategy (PFS) for open reduction internal fixation of intra-articular DRFs. Methods Radiology records were retrospectively reviewed by one trauma surgeon and two hand surgeons for 33 intra-articular DRFs that met the inclusion criteria and previously underwent open reduction internal fixation. Surgeons were initially provided only preoperative radiographs; they were asked for their PA and PFS. Three months later, each surgeon was provided with the same preoperative radiographs as well as a CT scan. They were asked for their PA and PFS and to grade the usefulness of CT for each fracture. Results The overall probability of having the same PA and PFS between the two presentations was 70.6% and 70.9%, respectively. There was a significant difference in opinion on the usefulness of the CT scan among the surgeons (P < .001). Conclusions This study suggests that ordering a CT scan for preoperative planning of open reduction internal fixation for an intra-articular DRF does not affect the approach or fixation strategy in the majority of cases, regardless of how useful a CT scan was determined to be by the surgeon. Type of study/level of evidence Therapeutic IV.
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Affiliation(s)
- Adam L. Haydel
- Department of Orthopaedics, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA
| | - Ryan C. Roubion
- Mississippi Sports Medicine and Orthopaedic Center, Jackson, MI
| | - Cristina T. Graphia
- Department of Orthopaedic Surgery and Rehabilitation Services, The University of Chicago, Chicago, IL
| | - Corinne E. Cloud
- Department of Orthopaedics, Cleveland Clinic Orthopaedic and Rheumatologic Institute, Cleveland, OH
| | - Claudia Leonardi
- Behavioral and Community Health Sciences, Louisiana State University Health Sciences Center School of Public Health, New Orleans, LA
| | - Christopher E. Marrero
- Department of Orthopaedics, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA
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Foster BK, Boualam B, Shea RP, Udoeyo IF, Luciani AM, Klena JC, Grandizio LC. Trends in the Utilization of Computed Tomography in Operative Treatment of Distal Radius Fractures. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:638-642. [PMID: 37790835 PMCID: PMC10543772 DOI: 10.1016/j.jhsg.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 04/13/2023] [Indexed: 10/05/2023] Open
Abstract
Purpose To identify patient, surgeon, and injury characteristics associated with preoperative computed tomography (CT) scan utilization for operative distal radius fractures (DRF). In addition, we aimed to determine if preoperative CT was associated with treatment methods other than isolated volar-locked plating (VLP). Methods We retrospectively reviewed all operatively treated adult DRFs within our health care system from 2016 to 2020. Baseline demographics, injury, treatment characteristics, and the fellowship training of the 44 included surgeons were recorded. We compared cases with and without a preoperative CT, and an adjusted logistic regression model was generated to determine the odds of having a preoperative CT. Results A total of 1,204 operatively treated DRFs performed by 44 surgeons were included. CT utilization increased during the study period. Intra-articular fractures accounted for 76% of cases, and preoperative CT scans were ordered in 243 of 1240 cases (20%). Overall, isolated VLP was used in 83% of cases. Cases with a preoperative CT were more likely to be treated with an alternative method of fixation (such as dorsal plating). The adjusted logistic regression model demonstrated that male sex (OR 1.62; 95% CI: 1.16, 2.26), intra-articular fractures (OR 3.11; 95% CI: 1.87, 5.81), and associated fractures (OR 2.69; 95% CI: 1.82, 3.98) had a significantly increased odds of having a preoperative CT. Fellowship training was not associated with increased CT utilization overall, but hand surgeons were more likely to use a CT in Orthopaedic Trauma Association-C3 fractures. Conclusions Patient and injury characteristics are associated with CT utilization in operative DRFs. Preoperative CTs are associated with alternative fixation approaches, as cases with a CT were more likely to use fixation methods other than isolated VLP. The costs and benefits of CT scans must be carefully weighed against whether this modality adds value or improves outcomes in treating DRFs. Level of evidence Prognostic II.
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Affiliation(s)
- Brian K. Foster
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Benchaa Boualam
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - R. Parker Shea
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Idorenyin F. Udoeyo
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - A. Michael Luciani
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Joel C. Klena
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
| | - Louis C. Grandizio
- Department of Orthopaedic Surgery, Geisinger Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Danville, PA
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Adult Distal Radius Fracture Management. J Am Acad Orthop Surg 2021; 29:e1105-e1116. [PMID: 34288886 DOI: 10.5435/jaaos-d-20-01335] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 06/18/2021] [Indexed: 02/01/2023] Open
Abstract
Distal radius fractures (DRFs) are some of the most commonly encountered fractures, and the incidence is increasing. Optimal treatment remains controversial. Critical evaluation of the initial imaging is necessary to recognize fracture characteristics and stability. The fracture pattern, injury mechanism, soft-tissue injury, patient characteristics, and surgeon preference are generally taken into consideration when choosing the most appropriate modality. Volar plating has become the workhorse of surgical DRF management but is not without complications. The surgeon should be comfortable using a wide variety of techniques to customize the fixation to the fracture pattern. Recognition of potential dangers and use of intraoperative imaging techniques can mitigate complications. Goals of rehabilitation after the initial treatment of DRF include regaining motion, strength, and ultimately function while managing pain.
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Brink M, Steenbakkers A, Holla M, de Rooy J, Cornelisse S, Edwards MJ, Prokop M. Single-shot CT after wrist trauma: impact on detection accuracy and treatment of fractures. Skeletal Radiol 2019; 48:949-957. [PMID: 30406835 PMCID: PMC6476997 DOI: 10.1007/s00256-018-3097-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/17/2018] [Accepted: 10/08/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate accuracy of fracture detection and therapeutic impact of a single-shot CT protocol as a primary imaging tool in all patients with clinical suspicion of wrist injury, and evaluate the resulting impact on therapy. MATERIALS AND METHODS We performed a single-institution study on all patients with suspicion of fractures of the wrist and carpus. All patients underwent conventional radiography, thereafter single-shot wrist CT, and then 1-year follow-up. Physicians and radiologists prospectively scored likelihood of fracture presence on a five-point scale before and after CT. Three surgeons proposed a treatment regimen (functional, cast, reduction, or operative) based on clinical and radiological data, first with knowledge of conventional radiography, and then with knowledge of CT. The reference standard for fracture presence was based on all data. We performed receiver operating characteristic (ROC) analyses and calculated proportion of wrists with treatment changes due to CT imaging. RESULTS Ninety-eight patients participated (63% female, mean age 53, range, 18-87 years old) with 100 wrist CTs. Conventional radiography detected true-positive fractures in 45, and CT in 61 wrists. The areas under the curve for fracture detection were 0.85 (95% CI 0.77-0.93) for conventional radiography and 0.97 (95% CI 0.93-1.00) for CT. Treatment changed in 24 (24%, 95% CI 16-33%) - 31 (31%, 95% CI 23-41%) wrists, mostly involving a decrease in the rate of cast immobilization. CONCLUSIONS Single-shot CT in patients with clinical suspicion of wrist injury increases accuracy of fracture detection. This has a significant impact therapy in this population, mainly on cast immobilization. TRIAL REGISTRATION We registered the study at www.clinicaltrials.gov , NL43482.091.13.
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Affiliation(s)
- Monique Brink
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre Nijmegen, huispost 780, PO Box 5601, 6500 HB Nijmegen, The Netherlands
| | - Arjan Steenbakkers
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre Nijmegen, huispost 780, PO Box 5601, 6500 HB Nijmegen, The Netherlands
| | - Micha Holla
- Department of Surgery, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Jacky de Rooy
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre Nijmegen, huispost 780, PO Box 5601, 6500 HB Nijmegen, The Netherlands
| | - Simon Cornelisse
- Department of Orthopedics, University Medical Center Groningen, Groningen, The Netherlands
| | - Michael J. Edwards
- Department of Surgery, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Mathias Prokop
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre Nijmegen, huispost 780, PO Box 5601, 6500 HB Nijmegen, The Netherlands
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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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Sugiyama Y, Naito K, Obata H, Kinoshita M, Goto K, Nagura N, Iwase Y, Kaneko K. Does pisiform subluxation affect the postoperative outcomes in a cohort of patients with distal radius fractures? Ann Med Surg (Lond) 2018; 35:73-75. [PMID: 30294433 PMCID: PMC6170207 DOI: 10.1016/j.amsu.2018.09.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 05/21/2018] [Accepted: 09/21/2018] [Indexed: 12/02/2022] Open
Abstract
Background In this study, we retrospectively surveyed the presence or absence of pisiform subluxation in surgically treated distal radius fractures (DRF) cases. In addition, we investigated whether or not the postoperative short-term treatment outcome differs due to the presence of pisiform subluxation. Materials and methods The subjects were 134 DRF patients treated with volar locking plate fixation (53 males and 81 females, mean age: 64 years old). The pisotriquetral joint was observed on a preoperative CT to investigate the presence or absence of pisiform subluxation according to the criteria reported by Vasilas. 134 patients divided into subluxation group and non-subluxation group, and the clinical outcomes were compared between these groups. Results Pisiform subluxation was noted in 23.1% (31 patients, 15 males and 16 females, mean age 61 years). No significant difference was noted in patient background in both groups. The postoperative pronation angle in the non-subluxation group was significantly greater than that in the subluxation group, but there was no significant difference in any other parameter (the range of motion of the wrist, grip strengths, VAS, Q-DASH scores, and Mayo score) between these 2 groups. However it concomitantly occurred in 23.1% of DRF cases in our series, there was no significant difference in the postoperative treatment outcome between these 2 groups. Conclusions Therapeutic intervention of pisiform subluxation is unnecessary during treatment of DRF, since pisiform subluxation does not affect the postoperative clinical outcomes of distal radius fractures. Pisiform subluxation occurred in 23.1% of distal radius fracture cases, suggesting that it is not a rare pathology. Therapeutic intervention of pisiform subluxation may be unnecessary during treatment of distal radius fracture. The therapeutic intervention of pisotriquetral joint disorders should be considered when they develop.
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Affiliation(s)
- Yoichi Sugiyama
- Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kiyohito Naito
- Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hiroyuki Obata
- Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Mayuko Kinoshita
- Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Kenji Goto
- Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Nana Nagura
- Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.,Department of Orthopaedic Surgery, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20 Shinsuna, Koto-ku, Tokyo, 136-0075, Japan
| | - Yoshiyuki Iwase
- Department of Orthopaedic Surgery, Juntendo Tokyo Koto Geriatric Medical Center, 3-3-20 Shinsuna, Koto-ku, Tokyo, 136-0075, Japan
| | - Kazuo Kaneko
- Department of Orthopaedics, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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NASCIMENTO VALDÊNIADASGRAÇAS, COSTA ANTONIOCARLOSDA, SILVA LEANDRORODRIGUESDA, FALCOCCHIO DIEGOFIGUEIRA, CHAKKOUR IVAN, CHECCHIA SERGIOLUIZ. PROPOSAL TOMOGRAPHIC CLASSIFICATION FOR INTRA-ARTICULAR DISTAL RADIUS FRACTURES. ACTA ORTOPEDICA BRASILEIRA 2018; 26:54-58. [PMID: 29977146 PMCID: PMC6025491 DOI: 10.1590/1413-785220182601179613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: The objective of this study was to present a proposal tomographic classification for intra-articular distal radius fractures. Methods: This descriptive study was based on observing tomographic images from 74 patients with distal radius fractures. The cases were grouped by similarity according to the presence of several parameters which determine fracture complexity; the results of the descriptive analysis were transcribed as tomographic classification. Results: The proposal tomographic classification for intra-articular distal radius fractures comprised three major groups and nine sub-groups, which are organized by increasing severity according to the presence of spacing between articular fragments, angulation, loss of radial height, cortical depression, and associated dislocation. Conclusion: This proposal tomographic classification for intra-articular distal radius fractures can help professionals indicate therapeutic options. Level of Evidence IV; Case series.
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Affiliation(s)
| | | | | | | | - IVAN CHAKKOUR
- Irmandade da Santa Casa de Misericórdia de São Paulo, Brazil
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Kleinlugtenbelt YV, Madden K, Groen SR, Ham SJ, Kloen P, Haverlag R, Simons MP, Bhandari M, Goslings JC, Scholtes VAB, Poolman RW. Can experienced surgeons predict the additional value of a CT scan in patients with displaced intra-articular distal radius fractures? Strategies Trauma Limb Reconstr 2017; 12:91-97. [PMID: 28439818 PMCID: PMC5505880 DOI: 10.1007/s11751-017-0283-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 04/03/2017] [Indexed: 11/29/2022] Open
Abstract
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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Affiliation(s)
- Y V Kleinlugtenbelt
- Department of Orthopaedic and Trauma Surgery, Joint Research OLVG, Oosterpark 9, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands. .,Department of Orthopaedic and Trauma Surgery, Deventer Ziekenhuis, Nico Bolkesteinlaan 75, 7416 SE, Deventer, The Netherlands. .,Division of Orthopaedic Surgery, McMaster University, 293 Wellington St N Suite 110, Hamilton, ON, L8L 8E7, Canada.
| | - K Madden
- Division of Orthopaedic Surgery, McMaster University, 293 Wellington St N Suite 110, Hamilton, ON, L8L 8E7, Canada
| | - S R Groen
- Department of Orthopaedic and Trauma Surgery, Joint Research OLVG, Oosterpark 9, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands
| | - S J Ham
- Department of Orthopaedic and Trauma Surgery, Joint Research OLVG, Oosterpark 9, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands
| | - P Kloen
- Department of Orthopaedic and Trauma Surgery, Academic Medical Centre, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - R Haverlag
- Department of General and Trauma Surgery, OLVG, Oosterpark 9, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands
| | - M P Simons
- Department of General and Trauma Surgery, OLVG, Oosterpark 9, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands
| | - M Bhandari
- Division of Orthopaedic Surgery, McMaster University, 293 Wellington St N Suite 110, Hamilton, ON, L8L 8E7, Canada
| | - J C Goslings
- Trauma Unit, Department of Surgery, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - V A B Scholtes
- Department of Orthopaedic and Trauma Surgery, Joint Research OLVG, Oosterpark 9, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands
| | - R W Poolman
- Department of Orthopaedic and Trauma Surgery, Joint Research OLVG, Oosterpark 9, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands
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Alluri RK, Hill JR, Ghiassi A. Distal Radius Fractures: Approaches, Indications, and Techniques. J Hand Surg Am 2016; 41:845-54. [PMID: 27342171 DOI: 10.1016/j.jhsa.2016.05.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/25/2016] [Indexed: 02/02/2023]
Abstract
Distal radius fractures remain among the most common fractures of the upper extremity. The indications for operative management continue to evolve based on outcomes from the most recent clinical studies. Advancements over the past decade have expanded the variety of fixation options available; however, the clinical superiority of a particular treatment modality remains without consensus. Each approach requires the use of unique surgical techniques, and the choice of a particular implant system should be based on the surgeon's familiarity with the implant design and its limitations. As our understanding of the management of distal radius fractures improves, so will our indications for each specific treatment modality.
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Affiliation(s)
- Ram K Alluri
- Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA
| | - J Ryan Hill
- Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA
| | - Alidad Ghiassi
- Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA.
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