The Role of CT in Changing the Classification and Treatment of the Fractures of the Distal Radius Compared With Conventional Radiography Regarding Interobserver Agreement

Objectives: Fractures of the distal end of the radius are very common and can lead to future degenerative changes if not treated properly. The computed tomographic (CT) scan is considered to show more precisely the steps and rotational deviations of these fractures but is not routinely used for init...

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Published in:Hand (New York, N.Y.) N.Y.), 2016-09, Vol.11 (1_suppl), p.40S-41S
Main Authors: Ferreira, Gustavo Pacheco Martins, de Andrade, Marco Antonio Percope, de Mendonça, Helio Pires, de Gouvea Schneiter, Henrique, Costa, Marcella Rodrigues
Format: Article
Language:English
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Summary:Objectives: Fractures of the distal end of the radius are very common and can lead to future degenerative changes if not treated properly. The computed tomographic (CT) scan is considered to show more precisely the steps and rotational deviations of these fractures but is not routinely used for initial patient assessment. The objective of the present study was to determine whether CT scan is useful for planning and treating the fractures of the distal radius in adults showing the level of interobserver agreement for classifying and treating fractures, and whether CT scan changes the directions of the treatment previously indicated only with conventional radiography. Materials and Methods: Five observers with similar professional backgrounds in hand surgery evaluated the CT scans and radiographs of 36 patients with fractures of the distal radius that were distributed by a moderator in a blind form, by chance. These patients were accepted and included in the study in a trauma reference hospital in the 6-month period. A total of 180 CT scans and 180 x-rays were evaluated. Fractures were classified using the universal and Arbeitsgemeinschaft für Osteosynthesefragen (AO) methods by the observers who indicated, as well, one of the five treatments previously predetermined, evaluating randomly the x-rays and CT scans on both situations. Interobserver agreement was researched for each one of the classifications and for the indication of treatment with the use of CT scan and x-ray thereafter. Results: The Kappa evaluation showed the same range of agreement (0.20-0.39) on both examinations. There were fewer indications of nonsurgical treatment (23 indications with CT scan against 41 with the x-ray) and an increased number of indications of more complex forms of treatment when CT scan was analyzed. Conclusions: It is concluded that CT scan and radiography have similar levels of interobserver agreement for classification and indication of treatment of fractures of the distal end of the radius. CT scan showed to be a useful imaging method, besides the use of radiography, for initial evaluation and also for indication of the treatment of fractures of the distal end of the radius. CT changed this indication in a significant way when compared with x-ray. Although some studies recommend CT only for indicating the preferred treatment option after the surgical decision, our study demonstrated that tomography evaluation is important even before the indication of the treatment
ISSN:1558-9447
1558-9455
DOI:10.1177/1558944716660555bj