title: Radiographic assessment of small finger metacarpal neck fractures.
abstract: Treatment recommendations for metacarpal neck fractures of the small finger are generally based on the degree of apex dorsal angulation at the fracture site. We evaluated the variability of measurement of fracture angulation and the effect this variability has on treatment recommendations for these injuries. A total of 96 radiographs (anteroposterior, lateral, oblique views) of 32 patients with fractures of the small finger metacarpal neck were evaluated independently by 3 fellowship-trained orthopedic hand surgeons. Treatment recommendations for each fracture were tabulated. This process was repeated 6 weeks later to evaluate intraobserver variability. Kappa coefficients of inter- and intraobserver reliability of fracture angulation measurement and treatment plans were generated. The mean reliability coefficient of the measurement of fracture angulation between the 3 different observers was slight. Similarly, the reproducibility of fracture angulation measurement within observers was fair. Agreement between observers for appropriate treatment recommendations for each fracture was fair and agreement within observers for treatment was only slightly better. The measurement of fracture angulation of small finger metacarpal neck fractures seems to be subject to a high degree of inter- and intraobserver variability.
authors.affiliation: Division of Hand Surgery, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
authors.forename: Y Leo
authors.initials: YL
authors.lastname: Leung
authors.forename: Pedro K
authors.initials: PK
authors.lastname: Beredjiklian
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Monaghan
authors.forename: David J
authors.initials: DJ
authors.lastname: Bozentka
mesh_terms: D005383:Finger Injuries / Q000000981:diagnostic imaging*; D050723:Fractures, Bone / Q000000981:diagnostic imaging*; D006801:Humans; D015601:Injury Severity Score; D008663:Metacarpus / Q000000981:diagnostic imaging* / Q000293:injuries; D015588:Observer Variation; D011859:Radiography; D015203:Reproducibility of Results; D012494:Sampling Studies; D012680:Sensitivity and Specificity