A Comparison of Intra-Observer and Inter-Observer Reliability of Plain Radiographs, Standard Computed Tomography Scans and Mobile Computed Tomography Scans in the Assessment of Distal Radius Fractures: A Cadaveric Study

Authors

  • Sitthiphong Suwannaphisit Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110,
  • Saowapar Yoykaew Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110,
  • Chitchaya Suwanraksa Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110,
  • Varah Yuenyongviwat Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110,
  • Porames Suwanno Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110,
  • Sittichoke Anuntaseree Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110,

DOI:

https://doi.org/10.31584/jhsmr.202078

Keywords:

computed tomography, distal radius fractures, Fernandez classification, imaging

Abstract

Objective: Diagnosis of a distal end radius fracture relies on various imaging studies. However, the relative usefulness of these studies is still a matter of some controversy. The aim of this study was to compare the intra-observer and inter-observer reliability of plain radiographs, standard computed tomography (CT) scans and mobile CT scans in the assessment of distal radius fractures as categorized by the Fernandez classification method. The secondary objective was to compare the dosages of radiation between the different imaging modalities.
Material and Methods: Sixteen fresh cadaveric wrist bones were used in this experimental study. The desired fractures were created in the bones to mimic Fernandez types I-V fractures and plain radiographs were taken in 4 views. Standard CT and mobile CT scans were also taken with the fractured bones in the same four positions. Interobserver reliability was assessed using Kappa statistics to determine the diagnostic consistency among the nine observers. Inter-observer agreement was assessed based on the Fernandez classification system diagnoses.
Results: Overall, the inter-observer agreement was substantial for the Fernandez classifications (Kappa range 0.636 0.727) in all types of imaging. For intra-observer agreement, the analysis found higher agreement for both standard CT scans and mobile CT scans. The standard CT images imparted a higher average dose of radiation than both the mobile CT scans and the plain radiographs.
Conclusion: The mobile CT scan can provide an alternative imaging method for precise diagnosis of distal end radius fractures, with the additional benefits of mobility and lower radiation exposure. 

References

Kleinlugtenbelt YV, Groen SR, Ham SJ, Kloen P, Haverlag R, Simons MP, et al. Classification systems for distal radius fractures. Acta Orthop 2017;88:681–7.

De Vos W, Casselman J, Swennen GRJ. Cone-beam computerized tomography (CBCT) imaging of the oral and maxillofacial region: a systematic review of the literature. Int J Oral Maxillofac Surg 2009;38:609–25.

Ludlow JB, Ivanovic M. Comparative dosimetry of dental CBCT devices and 64-slice CT for oral and maxillofacial radiology. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontology 2008;106:106–14.

Arealis G, Galanopoulos I, Nikolaou VS, Lacon A, Ashwood N, Kitsis C. Does the CT improve inter- and intra-observer agreement for the AO, Fernandez and Universal classifi cation systems for distal radius fractures? Injury 2014;45:1579–84. 5. Kleinlugtenbelt YV, Groen SR, Ham SJ, Kloen P, Haverlag R, Simons MP, et al. Classification systems for distal radius fractures: does the reliability improve using additional computed tomography? Acta Orthop 2017;88:681–7.

Shehovych A, Salar O, Meyer C, Ford D. Adult distal radius fractures classification systems: essential clinical knowledge or abstract memory testing? Ann R Coll Surg Engl 2016;98:525–31.

Mulders MAM, Rikli D, Goslings JC, Schep NWL. Classification and treatment of distal radius fractures: a survey among orthopaedic trauma surgeons and residents. Eur J Trauma Emerg Surg 2017;43:239–48.

Naqvi SGA, Reynolds T, Kitsis C. Interobserver reliability and intraobserver reproducibility of the Fernandez Classification for Distal Radius Fractures. J Hand Surg Eur Vol 2009;34:483–5.

Harness NG, Ring D, Zurakowski D, Harris GJ, Jupiter JB. The influence of three-dimensional computed tomography reconstructions on the characterization and treatment of distal radial fractures. J Bone Joint Surg Am 2006;88:1315–23.

Andersen DJ, Blair WF, Steyers CM, Adams BD, el-Khouri GY, Brandser EA. Classification of distal radius fractures: an analysis of interobserver reliability and intraobserver reproducibility. J Hand Surg 1996;21:574–82.

Ferrero A, Garavaglia G, Gehri R, Maenza F, Petri GJ, Fusetti C. Analysis of the inter- and intra-observer agreement in radiographic evaluation of wrist fractures using the multi media messaging service. Hand 2011;6:384–9.

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Published

2019-12-26

How to Cite

1.
Suwannaphisit S, Yoykaew S, Suwanraksa C, Yuenyongviwat V, Suwanno P, Anuntaseree S. A Comparison of Intra-Observer and Inter-Observer Reliability of Plain Radiographs, Standard Computed Tomography Scans and Mobile Computed Tomography Scans in the Assessment of Distal Radius Fractures: A Cadaveric Study. J Health Sci Med Res [Internet]. 2019 Dec. 26 [cited 2024 Mar. 29];38(1):53-9. Available from: https://he01.tci-thaijo.org/index.php/jhsmr/article/view/243490

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Original Article