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.
Key words
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Article info
Publication history
Published online: November 03, 2022
Accepted:
September 21,
2022
Received:
January 2,
2022
Publication stage
In Press Corrected ProofFootnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
