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Radiographic interpretation of distal radius fractures: visual estimations versus digital measuring techniques

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HAND

Abstract

Purpose

Distal radius fractures are a common injury. In the emergency room, trainees regularly assess these fractures using visual estimation. Our hypothesis is that assessment of radiographic parameters has sufficient accuracy for rendering treatment consistent with formal measurements.

Methods

This study compared visual measurements made by 25 orthopaedic residents and attending physicians to formal measurements made by a single fellowship trained musculoskeletal radiologist in a series of patients with distal radius fractures. A search was performed utilizing the ICD-9 code for distal radius fracture in all patients presenting to a single institution emergency department. Participants used visual estimation to rate 25 radiographs. Parameters estimated included radial inclination, radial height, volar tilt, and the presence of intra-articular displacement. Analysis using Lin concordance coefficients, Bland Altman plots, and the Kappa statistic evaluated the agreement between visual estimation and formal measurements. The proportion of raters whose estimates would have resulted in a course of treatment that conflicted with the formal reading quantified the potential impact of visual estimation on treatment.

Results

Concordance coefficients were poor for radial inclination (ρc = 0.13), radial height (ρc = 0.24), and volar tilt (ρc = 0.46). The Kappa statistic for intra-articular displacement was 0.4. Analysis performed according to level of training did not result in substantial improvements in these statistics. Treatment based on visual estimates conflicted with formal readings 34 % of the time for radial inclination, 38 % of the time for radial height, 27 % of the time for volar tilt, and 31 % of the time for intra-articular displacement.

Discussion

Visual estimation is not an adequate form of measurement for evaluation of patients with distal radius fractures. Physicians should be mindful of these results when developing treatment plans based solely upon visual estimation.

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Acknowledgments

The authors would like to acknowledge and thank the following individuals for their help in various roles of data collection and analysis: Greg Polkowski MD; Vinayak Sathe, MD; Michael Abramov, MD; Kyle Nuland, BS; and Bryan Lawlor BS.

Conflict of Interest

Michael P. O’Malley declares that he has no conflict of interest. Craig Rodner declares that he has no conflict of interest. Andrew Ritting declares that he has no conflict of interest. Mark P. Cote declares that he has no conflict of interest. Robin Leger declares that she has no conflict of interest. Harlan Stock is a reviewer for the Journal of Hand Surgery. Jennifer M. Wolf receives compensation as an editor for the Journal of Hand Surgery, as well as grant funding from OREF, AFSH, and NIH.

Statement of Human and Animal Rights

Procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 and 2008.

Statement of Informed Consent

All identifying factors are eliminated form the text, including but not limited to patients' names, initials, or hospital numbers. There are no patients that are identifiable within the text.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Connecticut Health Center, MARB Building, 263 Farmington Ave, Farmington, CT, 06031, USA

    Michael P. O’Malley, Craig Rodner, Andrew Ritting, Mark P. Cote, Robin Leger & Jennifer M. Wolf

  2. Department of Radiology, University of Connecticut Health Center, Farmington, CT, 06030, USA

    Harlan Stock

Authors
  1. Michael P. O’Malley
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  2. Craig Rodner
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  3. Andrew Ritting
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  4. Mark P. Cote
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  5. Robin Leger
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  6. Harlan Stock
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  7. Jennifer M. Wolf
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Corresponding author

Correspondence to Craig Rodner.

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O’Malley, M.P., Rodner, C., Ritting, A. et al. Radiographic interpretation of distal radius fractures: visual estimations versus digital measuring techniques. HAND 9, 488–493 (2014). https://doi.org/10.1007/s11552-014-9666-2

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  • DOI: https://doi.org/10.1007/s11552-014-9666-2

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