title: Radiographs Versus Radiographic Measurements in Distal Radius Fractures.
abstract: Surgeons use radiographic measures of deformity to help make treatment decisions in distal radius fractures. Precise threshold values are sometimes offered as a guide to treatment. The purpose was to evaluate if agreement on treatment recommendations would improve if surgeons were provided with radiographs rather than precise numeric radiographic measurements. We randomized 259 surgeons to review the scenarios of 30 consecutive adult patients with a distal radius fracture treated at our emergency department either with radiographs (135 surgeons) or with radiographic measurements (124 surgeons). Interrater reliability was measured with the Fleiss' generalized Kappa. Factors associated with a recommendation for operative treatment were sought in bivariate and multivariable analyses. Surgeons that received measurements only recommended operative treatment significantly more often, but were less likely to agree than surgeons evaluating actual radiographs. Patient factors - radiographic factors in particular - had a greater influence on treatment recommendation than surgeon factors. Agreement on treatment recommendations improved if surgeons were provided with radiographs instead of just measurements. There may be radiographic factors other than measures of deformity that some surgeons use to determine recommendations for surgery.
authors.affiliation: Orthopaedic Hand Service, Yawkey Center, Suite 2100, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA ; Division of Trauma Surgery, UniversityHospital Zurich, Zurich, CH-8091 Switzerland.
authors.forename: Valentin
authors.initials: V
authors.lastname: Neuhaus
authors.affiliation: Orthopaedic Hand Service, Yawkey Center, Suite 2100, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA.
authors.forename: Arjan G
authors.initials: AG
authors.lastname: Bot
authors.affiliation: Orthopaedic Hand Service, Yawkey Center, Suite 2100, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA.
authors.forename: Thierry G
authors.initials: TG
authors.lastname: Guitton
authors.affiliation: Orthopaedic Hand Service, Yawkey Center, Suite 2100, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Ring
keywords: Distal radius fracture; Interobserver agreement; Patient characteristics; Radiographic measurements; Radiographs; Surgeon characteristics