Orthopaedic Department, Hadassah Hebrew University Hospital, Jerusalem, Israel; Orthopedic Department, Shaare Zedek Medical Center, Jerusalem, Israel.
Orthopaedic Department, Hadassah Hebrew University Hospital, Jerusalem, Israel; Orthopedic Department, Emek Medical Center, Afula, Israel.
J Hand Surg Am. 2024 Aug;49(8):796.e1-796.e7. doi: 10.1016/j.jhsa.2022.09.015. Epub 2022 Nov 3.
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.
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.
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.
Providing computed RPs to orthopedic surgeons may improve the consistency of the radiographic judgment and influence their clinical decision for the treatment of DRFs.
Orthopedic surgeons' consistency in the radiographic judgment of DRFs slightly improved by providing automatically calculated radiographic measurements to them.
桡骨远端骨折（DRF）的手术治疗越来越常见。年龄、活动水平和合并症是影响治疗决策的主要因素，尽管手术指征仍存在争议。放射学参数（RPs），如桡骨倾斜度、背倾和关节台阶，可为有效决策提供客观支持。然而，RPs 的手动测量可能不够精确且存在不一致性。为了解决这个问题，我们开发了一种算法的定制软件，用于自动检测和计算 DRF 前后位和侧位 X 光片中的 6 个常见 RPs。本研究的目的是评估该软件对骨科医生 X 光片放射学观察者间变异性的影响。我们的假设是，RPs 的精确和一致测量将改善外科医生之间的放射学解释变异性，从而有助于临床决策。
将 35 例 DRF 的 X 光系列呈现给 9 名手部和骨科创伤 fellowship培训的外科医生。每个病例都提供了基本的临床信息，以及前后位和侧位 X 光片。选择了 2 种可能的治疗方案之一：石膏固定或锁定钢板切开复位。3 周后重复进行了调查，这次使用计算机生成的 RP 测量值。对两次调查的观察者间和观察者内变异性进行了数据分析，并计算了组内相关系数（ICC）、kappa 值。
提供 RP 后，观察者间可靠性（ICC 值）从差提高到中度，从 0.35 提高到 0.50。平均观察者内 ICC 为 0.68。当根据他们的专业（创伤和手部）对参与者进行单独评估时，也发现了观察者间变异性的改善。
向骨科医生提供计算的 RPs 可能会提高放射学判断的一致性，并影响他们对 DRF 治疗的临床决策。
向骨科医生提供自动计算的放射学测量值，他们对 DRF 的放射学判断的一致性略有提高。
