Jensen Janni, Graumann Ole, Gerke Oke, Torfing Trine, Precht Helle, Rasmussen Benjamin S, Tromborg Hans B
Department of Radiology, Odense University Hospital, Odense, Denmark.
Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark.
Acta Radiol Open. 2023 Sep 25;12(9):20584601231205986. doi: 10.1177/20584601231205986. eCollection 2023 Sep.
Management of the distal radius fracture (DRF) is to some extent based on radiographic characterization of fracture displacement. It remains unclear, however, if the measurements used to quantify displacement are accurate.
To quantify accuracy of two radiographic measurements: dorsal/volar tilt and fracture compression, measured indirectly as ulnar variance (UV), using radiostereometric analyses (RSA) as reference standard.
Twenty-one fresh frozen non-fractured human cadaveric forearms (right = 11, left = 10) were thawed and eligible for inclusion. The forearms were mounted on a custom made platform that allowed for controlled forearm rotation, and they underwent two rounds of imaging (both rounds consisted of RSA and radiographs). In round one, the non-fractured forearms were radiographed. In round two, artificial DRF´s with compression and dorsal angulation were created and imaging procedures repeated. Change in tilt and UV between the non-fractured and later fractured forearms was defined as fracture-induced deformity. Deformity was measured radiographically and additionally calculated using RSA. Bland Altman analyses were used to estimate agreement between radiographically measured, and RSA calculated, fracture-induced deformity.
Our results indicated that radiographs underestimate the amount of fracture-induced deformity. Mean measured differences (bias) in dorsal tilt deformity between radiographs and RSA were -2.5° for both observers. The corresponding values for UV were -1.4 mm and -1.5 mm.
Quantifying fracture-induced deformity on radiographs underestimated the actual deformity when compared to RSA calculated deformity. These findings suggest that clinicians, at least in part, base fracture management and potentially corrective surgery on inaccurate measurements.
桡骨远端骨折（DRF）的治疗在一定程度上基于骨折移位的影像学特征。然而，用于量化移位的测量方法是否准确仍不清楚。
以放射立体测量分析（RSA）作为参考标准，量化两种影像学测量的准确性：背侧/掌侧倾斜度和骨折压缩程度，后者通过尺骨变异（UV）间接测量。
解冻21具新鲜冷冻的未骨折人体尸体前臂（右侧11具，左侧10具），符合纳入标准。将前臂安装在定制平台上，该平台允许控制前臂旋转，并进行两轮成像（两轮成像均包括RSA和X线片）。在第一轮中，对未骨折的前臂进行X线片拍摄。在第二轮中，制造人工DRF并施加压缩和背侧成角，然后重复成像程序。未骨折前臂与后来骨折前臂之间的倾斜度和UV变化定义为骨折引起的畸形。通过X线片测量畸形，并另外使用RSA进行计算。采用Bland Altman分析来估计X线片测量的骨折引起的畸形与RSA计算的畸形之间的一致性。
我们的结果表明，X线片低估了骨折引起的畸形量。两位观察者的X线片与RSA之间背侧倾斜畸形的平均测量差异（偏差）均为-2.5°。UV的相应值分别为-1.4 mm和-1.5 mm。
与RSA计算的畸形相比，通过X线片量化骨折引起的畸形低估了实际畸形。这些发现表明，临床医生至少部分地基于不准确的测量来进行骨折治疗以及可能的矫正手术。
