Reliability of radiographic measurements for acute distal radius fractures

Narelle J. Watson, Saeed Asadollahi, Frank Parrish, Jacqueline Ridgway, Phong Tran, Jennifer L. Keating

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: The management of distal radial fractures is guided by the interpretation of radiographic findings. The aim of this investigation was to determine the intra- and inter-observer reliability of eight traditionally reported anatomic radiographic parameters in adults with an acute distal radius fracture. Methods: Five observers participated. All were routinely involved in making treatment decisions based on distal radius fracture radiographs. Observers performed independent repeated measurements on 30 radiographs for eight anatomical parameters: dorsal shift (mm), intra-articular gap (mm), intra-articular step (mm), palmar tilt (degrees), radial angle (degrees), radial height (mm), radial shift (mm), ulnar variance (mm). Intraclass correlation coefficients (ICCs) and the magnitude of retest errors were calculated. Results: Measurement reliability was summarised as high (ICC > 0.80), moderate (0.60-0.80) or low (<0.60). Intra-observer reliability was high for dorsal shift and palmar tilt; moderate for radial angle, radial height, ulnar variance and radial shift; and low for intra-articular gap and step. Inter-observer reliability was high for palmar tilt; moderate for dorsal shift, ulnar variance, radial angle and radial height; and low for radial shift, intra-articular gap and step. Error magnitude (95 % confidence interval) was within 1-2 mm for intra-articular gap and step, 2-4 mm for ulnar variance, 4-6 mm for radial shift, dorsal shift and radial height, and 6-8° for radial angle and palmar tilt. Conclusions: Based on previous reports of critical values for palmar tilt, ulnar variance and radial angle, error margins appear small enough for measurements to be useful in guiding treatment decisions. Our findings indicate that clinicians cannot reliably measure values ≤1 mm for intra-articular gap and step when interpreting radiographic parameters using the standardised methods investigated in this study. As a guide for treatment selection, palmar tilt, ulnar variance and radial angle measurements may be useful, but intra-articular gap and step appear unreliable.

Original languageEnglish
Article number44
JournalBMC Medical Imaging
Volume16
Issue number1
DOIs
Publication statusPublished - 22 Jul 2016

Keywords

  • Distal radius fracture
  • Radiographs
  • Reliability

Cite this

Watson, Narelle J. ; Asadollahi, Saeed ; Parrish, Frank ; Ridgway, Jacqueline ; Tran, Phong ; Keating, Jennifer L. / Reliability of radiographic measurements for acute distal radius fractures. In: BMC Medical Imaging. 2016 ; Vol. 16, No. 1.
@article{e398c46f4f2f4499a0118ecdb14598eb,
title = "Reliability of radiographic measurements for acute distal radius fractures",
abstract = "Background: The management of distal radial fractures is guided by the interpretation of radiographic findings. The aim of this investigation was to determine the intra- and inter-observer reliability of eight traditionally reported anatomic radiographic parameters in adults with an acute distal radius fracture. Methods: Five observers participated. All were routinely involved in making treatment decisions based on distal radius fracture radiographs. Observers performed independent repeated measurements on 30 radiographs for eight anatomical parameters: dorsal shift (mm), intra-articular gap (mm), intra-articular step (mm), palmar tilt (degrees), radial angle (degrees), radial height (mm), radial shift (mm), ulnar variance (mm). Intraclass correlation coefficients (ICCs) and the magnitude of retest errors were calculated. Results: Measurement reliability was summarised as high (ICC > 0.80), moderate (0.60-0.80) or low (<0.60). Intra-observer reliability was high for dorsal shift and palmar tilt; moderate for radial angle, radial height, ulnar variance and radial shift; and low for intra-articular gap and step. Inter-observer reliability was high for palmar tilt; moderate for dorsal shift, ulnar variance, radial angle and radial height; and low for radial shift, intra-articular gap and step. Error magnitude (95 {\%} confidence interval) was within 1-2 mm for intra-articular gap and step, 2-4 mm for ulnar variance, 4-6 mm for radial shift, dorsal shift and radial height, and 6-8° for radial angle and palmar tilt. Conclusions: Based on previous reports of critical values for palmar tilt, ulnar variance and radial angle, error margins appear small enough for measurements to be useful in guiding treatment decisions. Our findings indicate that clinicians cannot reliably measure values ≤1 mm for intra-articular gap and step when interpreting radiographic parameters using the standardised methods investigated in this study. As a guide for treatment selection, palmar tilt, ulnar variance and radial angle measurements may be useful, but intra-articular gap and step appear unreliable.",
keywords = "Distal radius fracture, Radiographs, Reliability",
author = "Watson, {Narelle J.} and Saeed Asadollahi and Frank Parrish and Jacqueline Ridgway and Phong Tran and Keating, {Jennifer L.}",
year = "2016",
month = "7",
day = "22",
doi = "10.1186/s12880-016-0147-7",
language = "English",
volume = "16",
journal = "BMC Medical Imaging",
issn = "1471-2342",
publisher = "Springer-Verlag London Ltd.",
number = "1",

}

Reliability of radiographic measurements for acute distal radius fractures. / Watson, Narelle J.; Asadollahi, Saeed; Parrish, Frank; Ridgway, Jacqueline; Tran, Phong; Keating, Jennifer L.

In: BMC Medical Imaging, Vol. 16, No. 1, 44, 22.07.2016.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Reliability of radiographic measurements for acute distal radius fractures

AU - Watson, Narelle J.

AU - Asadollahi, Saeed

AU - Parrish, Frank

AU - Ridgway, Jacqueline

AU - Tran, Phong

AU - Keating, Jennifer L.

PY - 2016/7/22

Y1 - 2016/7/22

N2 - Background: The management of distal radial fractures is guided by the interpretation of radiographic findings. The aim of this investigation was to determine the intra- and inter-observer reliability of eight traditionally reported anatomic radiographic parameters in adults with an acute distal radius fracture. Methods: Five observers participated. All were routinely involved in making treatment decisions based on distal radius fracture radiographs. Observers performed independent repeated measurements on 30 radiographs for eight anatomical parameters: dorsal shift (mm), intra-articular gap (mm), intra-articular step (mm), palmar tilt (degrees), radial angle (degrees), radial height (mm), radial shift (mm), ulnar variance (mm). Intraclass correlation coefficients (ICCs) and the magnitude of retest errors were calculated. Results: Measurement reliability was summarised as high (ICC > 0.80), moderate (0.60-0.80) or low (<0.60). Intra-observer reliability was high for dorsal shift and palmar tilt; moderate for radial angle, radial height, ulnar variance and radial shift; and low for intra-articular gap and step. Inter-observer reliability was high for palmar tilt; moderate for dorsal shift, ulnar variance, radial angle and radial height; and low for radial shift, intra-articular gap and step. Error magnitude (95 % confidence interval) was within 1-2 mm for intra-articular gap and step, 2-4 mm for ulnar variance, 4-6 mm for radial shift, dorsal shift and radial height, and 6-8° for radial angle and palmar tilt. Conclusions: Based on previous reports of critical values for palmar tilt, ulnar variance and radial angle, error margins appear small enough for measurements to be useful in guiding treatment decisions. Our findings indicate that clinicians cannot reliably measure values ≤1 mm for intra-articular gap and step when interpreting radiographic parameters using the standardised methods investigated in this study. As a guide for treatment selection, palmar tilt, ulnar variance and radial angle measurements may be useful, but intra-articular gap and step appear unreliable.

AB - Background: The management of distal radial fractures is guided by the interpretation of radiographic findings. The aim of this investigation was to determine the intra- and inter-observer reliability of eight traditionally reported anatomic radiographic parameters in adults with an acute distal radius fracture. Methods: Five observers participated. All were routinely involved in making treatment decisions based on distal radius fracture radiographs. Observers performed independent repeated measurements on 30 radiographs for eight anatomical parameters: dorsal shift (mm), intra-articular gap (mm), intra-articular step (mm), palmar tilt (degrees), radial angle (degrees), radial height (mm), radial shift (mm), ulnar variance (mm). Intraclass correlation coefficients (ICCs) and the magnitude of retest errors were calculated. Results: Measurement reliability was summarised as high (ICC > 0.80), moderate (0.60-0.80) or low (<0.60). Intra-observer reliability was high for dorsal shift and palmar tilt; moderate for radial angle, radial height, ulnar variance and radial shift; and low for intra-articular gap and step. Inter-observer reliability was high for palmar tilt; moderate for dorsal shift, ulnar variance, radial angle and radial height; and low for radial shift, intra-articular gap and step. Error magnitude (95 % confidence interval) was within 1-2 mm for intra-articular gap and step, 2-4 mm for ulnar variance, 4-6 mm for radial shift, dorsal shift and radial height, and 6-8° for radial angle and palmar tilt. Conclusions: Based on previous reports of critical values for palmar tilt, ulnar variance and radial angle, error margins appear small enough for measurements to be useful in guiding treatment decisions. Our findings indicate that clinicians cannot reliably measure values ≤1 mm for intra-articular gap and step when interpreting radiographic parameters using the standardised methods investigated in this study. As a guide for treatment selection, palmar tilt, ulnar variance and radial angle measurements may be useful, but intra-articular gap and step appear unreliable.

KW - Distal radius fracture

KW - Radiographs

KW - Reliability

UR - http://www.scopus.com/inward/record.url?scp=84978985674&partnerID=8YFLogxK

U2 - 10.1186/s12880-016-0147-7

DO - 10.1186/s12880-016-0147-7

M3 - Article

VL - 16

JO - BMC Medical Imaging

JF - BMC Medical Imaging

SN - 1471-2342

IS - 1

M1 - 44

ER -