Department of Traumatology and Sports Injuries, University of Salzburg, Salzburg, 5020, Muellner Hauptstrasse 48, Austria.
Skeletal Radiol. 2012 Sep;41(10):1239-44. doi: 10.1007/s00256-012-1436-z. Epub 2012 May 29.
The purpose of the present study was to compare the intra- and interobserver reliability of two different measurement methods for volar angulation of the 5th metacarpal (MC) in an attempt to establish a new standard measurement method to reduce interobserver discrepancies for therapeutic decisions.
Twenty patients with subcapital fractures of the 5th MC were radiologically investigated. Imaging consisted of a radiographs in antero-posterior and precise lateral view in addition to a CT scan of the 5th MC. Measurement of volar angulation was accomplished using the conventional and the shaft articular surface (SAS) method. The measurements of five investigators were exported to a spreadsheet for statistical analysis to evaluate the intra-and interobserver reliability.
The conventional technique showed large differences among the investigators and poor interobserver reliability (W = 0.328 and 0.307) both at injury (p = 0.001) and at follow-up (p = 0.189). The intraobserver concordance of all investigators showed better results with the SAS than with the conventional technique. With the SAS technique, no statistically significant difference among the investigators could be detected at either the time of injury (p = 0.418) or at follow-up (p = 0.526) with excellent interobserver reliability (W = 0.051 and W = 0.041). Evaluation of volar angulation at follow-up using CT scans did not show any statistically significant difference between the techniques with better correlation among the observers with the SAS technique (p = 0.838).
The interobserver correlation of volar angulation with lateral radiographs using the conventional technique was insufficient. Therefore, we recommend the use of the novel SAS technique as standardized measurement method which showed higher accuracy and interobserver reliability in order to facilitate the choice of adequate treatment option.
A CT scan should be performed in cases with ambivalent treatment options.
Evidence-Based Medicine Level II.
本研究旨在比较两种不同的第 5 掌骨掌侧角（MC）测量方法的观察者内和观察者间可靠性，以期建立一种新的标准测量方法，减少治疗决策中的观察者间差异。
对 20 例第 5 掌骨干骺端骨折患者进行影像学检查。影像学检查包括前后位和精确侧位 X 线片，以及第 5 掌骨 CT 扫描。采用传统方法和骨干关节面（SAS）方法测量掌侧角。将 5 名观察者的测量结果导出到电子表格中进行统计分析，以评估观察者内和观察者间的可靠性。
传统技术的观察者间差异较大，可靠性较低（W = 0.328 和 0.307），受伤时（p = 0.001）和随访时（p = 0.189）均如此。所有观察者的观察者内一致性均显示 SAS 技术优于传统技术。使用 SAS 技术，在受伤时（p = 0.418）或随访时（p = 0.526），观察者间均无统计学差异，观察者间可靠性较高（W = 0.051 和 W = 0.041）。使用 CT 扫描评估随访时的掌侧角，两种技术之间无统计学差异，SAS 技术的观察者间相关性更好（p = 0.838）。
使用传统技术测量侧位 X 线片的掌侧角时，观察者间相关性不足。因此，我们建议使用新的 SAS 技术作为标准化测量方法，以提高准确性和观察者间可靠性，从而有助于选择合适的治疗方案。
对于有治疗选择分歧的病例，应进行 CT 扫描。
循证医学 II 级。
