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Hendrix N, Hendrix W, Maresch B, van Amersfoort J, Oosterveld-Bonsma T, Kolderman S, Vestering M, Zielinski S, Rutten K, Dammeier J, Ong LLS, van Ginneken B, Rutten M. Artificial intelligence for automated detection and measurements of carpal instability signs on conventional radiographs. Eur Radiol 2024:10.1007/s00330-024-10744-1. [PMID: 38634877 DOI: 10.1007/s00330-024-10744-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/26/2024] [Accepted: 03/21/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES To develop and validate an artificial intelligence (AI) system for measuring and detecting signs of carpal instability on conventional radiographs. MATERIALS AND METHODS Two case-control datasets of hand and wrist radiographs were retrospectively acquired at three hospitals (hospitals A, B, and C). Dataset 1 (2178 radiographs from 1993 patients, hospitals A and B, 2018-2019) was used for developing an AI system for measuring scapholunate (SL) joint distances, SL and capitolunate (CL) angles, and carpal arc interruptions. Dataset 2 (481 radiographs from 217 patients, hospital C, 2017-2021) was used for testing, and with a subsample (174 radiographs from 87 patients), an observer study was conducted to compare its performance to five clinicians. Evaluation metrics included mean absolute error (MAE), sensitivity, and specificity. RESULTS Dataset 2 included 258 SL distances, 189 SL angles, 191 CL angles, and 217 carpal arc labels obtained from 217 patients (mean age, 51 years ± 23 [standard deviation]; 133 women). The MAE in measuring SL distances, SL angles, and CL angles was respectively 0.65 mm (95%CI: 0.59, 0.72), 7.9 degrees (95%CI: 7.0, 8.9), and 5.9 degrees (95%CI: 5.2, 6.6). The sensitivity and specificity for detecting arc interruptions were 83% (95%CI: 74, 91) and 64% (95%CI: 56, 71). The measurements were largely comparable to those of the clinicians, while arc interruption detections were more accurate than those of most clinicians. CONCLUSION This study demonstrates that a newly developed automated AI system accurately measures and detects signs of carpal instability on conventional radiographs. CLINICAL RELEVANCE STATEMENT This system has the potential to improve detections of carpal arc interruptions and could be a promising tool for supporting clinicians in detecting carpal instability.
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Affiliation(s)
- Nils Hendrix
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
- Jheronimus Academy of Data Science, Sint Janssingel 92, 5211 DA, 's-Hertogenbosch, The Netherlands.
| | - Ward Hendrix
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Department of Radiology, Jeroen Bosch Ziekenhuis, Henri Dunantstraat 1, 5223 GZ, 's-Hertogenbosch, The Netherlands
| | - Bas Maresch
- Department of Radiology, Ziekenhuis Gelderse Vallei, Willy Brandtlaan 10, 6717 RP, Ede, The Netherlands
| | - Job van Amersfoort
- Department of Surgery, Ziekenhuis Gelderse Vallei, Willy Brandtlaan 10, 6717 RP, Ede, The Netherlands
| | - Tineke Oosterveld-Bonsma
- Department of Radiology, Ziekenhuis Gelderse Vallei, Willy Brandtlaan 10, 6717 RP, Ede, The Netherlands
| | - Stephanie Kolderman
- Department of Radiology, Ziekenhuis Gelderse Vallei, Willy Brandtlaan 10, 6717 RP, Ede, The Netherlands
| | - Myrthe Vestering
- Department of Radiology, Ziekenhuis Gelderse Vallei, Willy Brandtlaan 10, 6717 RP, Ede, The Netherlands
| | - Stephanie Zielinski
- Department of Surgery, Ziekenhuis Gelderse Vallei, Willy Brandtlaan 10, 6717 RP, Ede, The Netherlands
| | - Karlijn Rutten
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Jan Dammeier
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Lee-Ling Sharon Ong
- Jheronimus Academy of Data Science, Sint Janssingel 92, 5211 DA, 's-Hertogenbosch, The Netherlands
- Cognitive Science and Artificial Intelligence Department, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, The Netherlands
| | - Bram van Ginneken
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Matthieu Rutten
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Department of Radiology, Jeroen Bosch Ziekenhuis, Henri Dunantstraat 1, 5223 GZ, 's-Hertogenbosch, The Netherlands
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Crowe CS, Kakar S. Periarticular distal radius fractures and complex ligamentous injury: The role of arthroscopic evaluation. J Orthop 2023; 42:6-12. [PMID: 37389206 PMCID: PMC10302116 DOI: 10.1016/j.jor.2023.06.006] [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: 03/27/2023] [Revised: 06/02/2023] [Accepted: 06/12/2023] [Indexed: 07/01/2023] Open
Abstract
Purpose Distal radius fractures are associated with a high incidence of concomitant soft tissue injuries, including lesions of the triangular fibrocartilage complex and intercarpal ligaments. While advanced imaging has allowed for greater identification of such tears, discerning which lesions pose a functional consequence remains a challenge for the hand surgeon. A review and guideline for arthroscopic evaluation of suspected combined injuries is presented. Results Arthroscopic evaluation of distal radius fractures provides several unique advantages in such instances. Articular reduction can be performed via direct visualization with improvement in step-off and gapping. Furthermore, ligamentous injuries and carpal alignment can be directly assessed and treated. Conclusions Subtle features of combined ligamentous trauma may be overlooked in the presence of more obvious fracture patterns. Wrist arthroscopy allows not only for a gold-standard method of evaluating of these soft tissue injuries, but also a means of treatment.
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Affiliation(s)
- Christopher S. Crowe
- Division of Hand and Upper Extremity Surgery, Department of Orthopaedics, Mayo Clinic, United States
| | - Sanjeev Kakar
- Division of Hand and Upper Extremity Surgery, Department of Orthopaedics, Mayo Clinic, United States
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Lans J, Lasa A, Chen NC, Jupiter JB. Incidence and Functional Outcomes of Scapholunate Diastases Associated Distal Radius Fractures: A 2-year Follow-Up Scapholunate Dissociation. Open Orthop J 2018; 12:33-40. [PMID: 29456778 PMCID: PMC5806195 DOI: 10.2174/1874325001812010033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 01/20/2018] [Accepted: 01/23/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The Scapholunate Interosseous Ligament (SLIL) is the first intrinsic carpal ligament to be injured in wrist trauma, present in up to 64% of the distal radius fractures. However, it remains unclear what patients develop symptoms, making primary treatment of these injuries accompanying distal radius fractures remains questionable. OBJECTIVE The aim of this study was to evaluate the functional outcomes of patients with scapholunate diastasis associated with distal radius fractures. METHODS We evaluated 391 patients with a distal radius fracture. Using Computer Tomography (CT) scans the scapholunate interval was measured. We identified 14 patients with an SLD (>3mm) of the injured wrist, which underwent a CT-scan of the contralateral wrist. To evaluate the functional outcomes at a mean follow up of 136±90 weeks, we used the Quick Disabilities of the Arm, Shoulder and Hand (qDASH) Score. RESULTS There were 8 patients with bilateral SLD and 6 patients with unilateral SLD. Five patients had a qDASH score of 0 and one patient showed a qDASH score of 18.2. The patient with a poor score had bilateral preexisting osteoarthritis of the wrist. No patient had additional surgery of the SLIL. CONCLUSION In patients with distal radius fractures, more than half of the 14 patients with an SL gap on CT had widening on the contralateral side. It is therefore worthwhile to image the contralateral wrist before diagnosing a SLD. The patients with unilateral SLD should not be surgically treated at initial presentation because they may have good functional outcomes after a follow up of 2 years.
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Affiliation(s)
- Jonathan Lans
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA, 02114, USA
| | - Alejandro Lasa
- Department of Traumatology, British Hospital, Avenida Italia 2420, 11600 Montevideo, Uruguay
| | - Neal C. Chen
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA, 02114, USA
| | - Jesse B. Jupiter
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA, 02114, USA
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Finsen V, Rajabi B, Rod O, Roed K, Alm-Paulsen PS, Russwurm H. The clinical outcome after extra-articular colles fractures with simultaneous moderate scapholunate dissociation. J Wrist Surg 2014; 3:123-127. [PMID: 25077048 PMCID: PMC4078185 DOI: 10.1055/s-0034-1372514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background An increased scapholunate gap is sometimes seen in patients with a distal radial fracture. The question remains as to whether this represents a scapholunate ligament injury that requires treatment. Questions/purposes We wished to examine the natural history of an increased scapholunate gap in patients following an extra-articular distal radial fracture. Patients and Methods We reviewed 260 patients who had sustained a distal radial fracture at a mean of 6.2 (2.7-11.9) years previously and identified 12 extra-articular fractures with an increased gap between the lunate and scaphoid. The mean scapholunate gap was 2.6 (2.1-3.4) mm, and the mean scapholunate angle 62° (39°-90°). Controls were found among the remaining patients with extra-articular fractures. Selection criteria were same sex, age at fracture within 5 years, time between injury and review within 2 years, ulnar variance within 2 mm, and dorsal angulation within 5° of index patient. When more than one control fulfilled the criteria for an index patient, their values were averaged. In total there were 54 controls for the 12 index patients. Results The mean difference between index patients and controls in wrist range of motion was 4%, in grip strength 5%, in visual analog scale (VAS) for pain 1 (on a scale from 1 to 100), in Quick-DASH (Disability of the Arm, Shoulder, and Hand) score 5, and in PRWE score 1. The study was calculated to have the power to detect a difference in Quick-DASH scores and in Patient-Rated Wrist Evaluation (PRWE) scores of 14. Conclusions We conclude that at a mean follow up of 6.2 years following an extra-articular distal radial fracture, no surgical treatment is usually needed with a scapholunate gap of between 2.1-3.4 mm. Level of Evidence III, Case control study.
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Affiliation(s)
- Vilhjalmur Finsen
- Department of Orthopaedic Surgery, St. Olav's University Hospital, Trondheim, Norway
- Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Benjamin Rajabi
- Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Oyvind Rod
- Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kristian Roed
- Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Harald Russwurm
- Department of Orthopaedic Surgery, St. Olav's University Hospital, Trondheim, Norway
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