title: Comparison of plain x-rays and computed tomography for assessing distal radioulnar joint inclination.
abstract: OBJECTIVE
  To compare the inclination of the distal radioulnar joint (DRUJ) on computed tomography (CT) and plain radiography (XR) in order to assess the effect of narrowing the range of inclination used in the original Tolat classification system to identify potentially problematic reverse oblique DRUJs.
  
  
  METHODS
  Two independent investigators compared the angle of inclination and Tolat type on matched wrist XRs in the coronal plane and CTs of the same patients with normal DRUJs. The degree of agreement between XR and CT was determined. Inter- and intra-observer reliabilities were calculated. The prevalence of the 3 inclination types of the DRUJs using Tolat's definition was recorded. Their original quantitative definition of the parallel Tolat type 1 DRUJ included all DRUJs with a measured inclination of ±10°. We noted and compared the resultant changes in prevalence of the different DRUJ types after narrowing the inclination range to ±5° and ±3°.
  
  
  RESULTS
  Highly significant correlation between CT and XR measurements were found for both observers. Despite this, the limits of agreement between CT and XR in determining the sigmoid notch inclination was -9° to 11° (±2° standard deviations from the mean difference). When measured from the CTs and using Tolat's original algorithm, the prevalence of Tolat type 1 DRUJ was 47% (N = 34), type 2 was 51% (N = 37), and type 3 was 1% (N = 1). These percentages changed to 7% (N = 5) for type 1, 78% (N = 56) for type 2, and 15% (N = 11) for type 3 when applying narrower ranges of inclination.
  
  
  CONCLUSIONS
  Narrowing the range of sigmoid notch inclination that defines type 1 (parallel) DRUJs when using CT provided a more accurate representation of the morphological types. It revealed an increased number of potentially problematic type 3 DRUJs. However, the statistical limits of agreement between CT and XR suggested that high-resolution 3-dimensional imaging is required to apply the new algorithm.
  
  
  METHODS
  Diagnostic II.
authors.affiliation: Department of Orthopaedics, Princess Alexandra Hospital, Brisbane, Australia; University of Queensland; Brisbane Hand and Upper Limb Research Institute, Brisbane, Australia; Orthopaedic Department, Barts and Royal London Hospital, London, UK.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Heiss-Dunlop
authors.affiliation: Department of Orthopaedics, Princess Alexandra Hospital, Brisbane, Australia; University of Queensland; Brisbane Hand and Upper Limb Research Institute, Brisbane, Australia; Orthopaedic Department, Barts and Royal London Hospital, London, UK.
authors.forename: Gregory B
authors.initials: GB
authors.lastname: Couzens
authors.affiliation: Department of Orthopaedics, Princess Alexandra Hospital, Brisbane, Australia; University of Queensland; Brisbane Hand and Upper Limb Research Institute, Brisbane, Australia; Orthopaedic Department, Barts and Royal London Hospital, London, UK.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Peters
authors.affiliation: Department of Orthopaedics, Princess Alexandra Hospital, Brisbane, Australia; University of Queensland; Brisbane Hand and Upper Limb Research Institute, Brisbane, Australia; Orthopaedic Department, Barts and Royal London Hospital, London, UK.
authors.forename: Karl
authors.initials: K
authors.lastname: Gadd
authors.affiliation: Department of Orthopaedics, Princess Alexandra Hospital, Brisbane, Australia; University of Queensland; Brisbane Hand and Upper Limb Research Institute, Brisbane, Australia; Orthopaedic Department, Barts and Royal London Hospital, London, UK.
authors.forename: Livio
authors.initials: L
authors.lastname: Di Mascio
authors.affiliation: Department of Orthopaedics, Princess Alexandra Hospital, Brisbane, Australia; University of Queensland; Brisbane Hand and Upper Limb Research Institute, Brisbane, Australia; Orthopaedic Department, Barts and Royal London Hospital, London, UK. Electronic address: research@upperlimb.com.
authors.forename: Mark
authors.initials: M
authors.lastname: Ross
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D011857:Radiographic Image Interpretation, Computer-Assisted; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed; D014954:Wrist Injuries / Q000000981:diagnostic imaging*; D014955:Wrist Joint / Q000000981:diagnostic imaging*; D014965:X-Rays
keywords: Computed tomograph; distal radio-ulna joint; plain radiograph; ulna shortening osteotomy