title: Direct comparison of conventional radiography and cone-beam CT in small bone and joint trauma.
abstract: OBJECTIVE
  To compare the diagnostic value of cone-beam computed tomography (CBCT) and conventional radiography (CR) after acute small bone or joint trauma.
  
  
  METHODS
  Between March 2013 and January 2014, 231 patients with recent small bone or joint trauma underwent CR and subsequent CBCT. CR and CBCT examinations were independently assessed by two readers, blinded to the result of the other modality. The total number of fractures as well as the number of complex fractures were compared, and inter- and intraobserver agreement for CBCT was calculated. In addition, radiation doses and evaluation times for both modalities were noted and statistically compared.
  
  
  RESULTS
  Fracture detection on CBCT increased by 35% and 37% for reader 1 and reader 2, respectively, and identification of complex fractures increased by 236% and 185%. Interobserver agreement for CBCT was almost perfect, as was intraobserver agreement for reader 1. The intraobserver agreement for reader 2 was substantial. Radiation doses and evaluation time were significantly higher for CBCT.
  
  
  CONCLUSIONS
  CBCT detects significantly more small bone and joint fractures, in particular complex fractures, than CR. In the majority of cases, the clinical implication of the additionally detected fractures is limited, but in some patients (e.g., fracture-dislocations), the management is significantly influenced by these findings. As the radiation dose for CBCT substantially exceeds that of CR, we suggest adhering to CR as the first-line examination after small bone and joint trauma and keeping CBCT for patients with clinical-radiographic discordance or suspected complex fractures in need of further (preoperative) assessment.
authors.affiliation: Department of Radiology, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium, elinedesmet@hotmail.com.
authors.forename: E
authors.initials: E
authors.lastname: De Smet
authors.forename: G
authors.initials: G
authors.lastname: De Praeter
authors.forename: K L A
authors.initials: KL
authors.lastname: Verstraete
authors.forename: K
authors.initials: K
authors.lastname: Wouters
authors.forename: Luc
authors.initials: L
authors.lastname: De Beuckeleer
authors.forename: F M H M
authors.initials: FM
authors.lastname: Vanhoenacker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001175:Arthrography / Q000379:methods*; D002648:Child; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging*; D006801:Humans; D007596:Joints / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000032:analysis*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D014962:X-Ray Film; D055815:Young Adult