title: Visual and computer software-aided estimates of Dupuytren's contractures: correlation with clinical goniometric measurements.
abstract: BACKGROUND
  Corrective surgery for Dupuytren's disease represents a significant proportion of a hand surgeon's workload. The decision to go ahead with surgery and the success of surgery requires measuring the degree of contracture of the diseased finger(s). This is performed in clinic with a goniometer, pre- and postoperatively. Monitoring the recurrence of the contracture can inform on surgical outcome, research and audit.
  
  
  METHODS
  We compared visual and computer software-aided estimation of Dupuytren's contractures to clinical goniometric measurements in 60 patients with Dupuytren's disease. Patients' hands were digitally photographed. There were 76 contracted finger joints--70 proximal interphalangeal joints and six distal interphalangeal joints. The degrees of contracture of these images were visually assessed by six orthopaedic staff of differing seniority and re-assessed with computer software.
  
  
  RESULTS
  Across assessors, the Pearson correlation between the goniometric measurements and the visual estimations was 0.83 and this significantly improved to 0.88 with computer software. Reliability with intra-class correlations achieved 0.78 and 0.92 for the visual and computer-aided estimations, respectively, and with test-retest analysis, 0.92 for visual estimation and 0.95 for computer-aided measurements.
  
  
  CONCLUSIONS
  Visual estimations of Dupuytren's contractures correlate well with actual clinical goniometric measurements and improve further if measured with computer software. Digital images permit monitoring of contracture after surgery and may facilitate research into disease progression and auditing of surgical technique.
authors.affiliation: Department of Orthopaedic Surgery, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK.
authors.forename: R P
authors.initials: RP
authors.lastname: Smith
authors.forename: J J
authors.initials: JJ
authors.lastname: Dias
authors.forename: A
authors.initials: A
authors.lastname: Ullah
authors.forename: B
authors.initials: B
authors.lastname: Bhowal
mesh_terms: D053587:Arthrometry, Articular / Q000379:methods*; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004387:Dupuytren Contracture / Q000175:diagnosis* / Q000503:physiopathology; D005384:Finger Joint / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D015588:Observer Variation; D010781:Photography; D016059:Range of Motion, Articular / Q000502:physiology; D014741:Video Recording / Q000379:methods