title: AO type-C distal radius fractures: the influence of computed tomography on surgeon's decision-making.
abstract: BACKGROUND
  Computed tomography (CT) has become a widely accepted adjunct imaging tool in the preoperative evaluation of complex intra-articular distal radius fractures. The aim of this study was to evaluate the impact of CT scanning compared with plain X-rays on the choice of intervention in complex distal radius fractures.
  
  
  METHODS
  Five orthopaedic surgeons were given the de-identified plain films (AP, lateral and oblique) of 20 closed complex intra-articular distal radius fractures (AO23-C), randomly selected from our institution's prospectively maintained fracture database. Each surgeon individually selected a management option for each patient from a series of five interventions, ranked in increasing level of invasiveness. The same patients' CT scans (in randomized order) were blindly reviewed after a 1-week interval by the same clinicians with the same management options again offered. Kappa statistic was used to measure the intra-observer agreement between X-ray and CT decisions, and inter-observer agreement within each modality.
  
  
  RESULTS
  The intra-observer agreement on management between X-rays alone versus CT scan was poor, with an average kappa score of 0.038. Inter-observer agreement based on X-ray alone was higher than that based on CT alone. Regression analysis indicated a trend towards a slightly higher level of invasiveness when the management decision was based on the CT compared with plain X-rays.
  
  
  CONCLUSIONS
  There is a very poor intra- and inter-rater agreement between decision-making based on X-ray and on CT. Decision-making based on CT could increase the level of invasiveness in the surgical management of complex distal radius fractures.
authors.affiliation: Department of Orthopaedics, John Hunter Hospital and University of Newcastle, Newcastle, New South Wales, Australia.
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Hunt
authors.forename: William
authors.initials: W
authors.lastname: Lumsdaine
authors.forename: John
authors.initials: J
authors.lastname: Attia
authors.forename: Zsolt J
authors.initials: ZJ
authors.lastname: Balogh
mesh_terms: D016208:Databases, Factual; D003661:Decision Support Techniques; D005592:Fracture Fixation / Q000379:methods*; D006801:Humans; D015588:Observer Variation; D011885:Radius Fractures / Q000000981:diagnostic imaging* / Q000601:surgery; D012044:Regression Analysis; D016037:Single-Blind Method; D014057:Tomography, X-Ray Computed
keywords: Kirschner wires; computed tomography; external fixators; internal fixation; radius fracture