title: Does Computed Tomography Change our Observation and Management of Fracture Non-Unions?
abstract: BACKGROUND
  The purpose of this study was to determine whether Multi-Detector Computed Tomography (MDCT) in addition to plain radiographs influences radiologists' and orthopedic surgeons' diagnosis and treatment plans for delayed unions and non-unions.
  
  
  METHODS
  A retrospective database of 32 non-unions was reviewed by 20 observers. On a scale of 1 to 5, observers rated on X-Ray and a subsequent Multi Detector Helical Computer Tomography (MDCT) scan was performed to determine the following categories: "healed", "bridging callus present", "persistent fracture line" or "surgery advised". Interobserver reliability in each category was calculated using the Interclass Correlation Coefficient (ICC). The influence of the MDCT scan on the raters' observations was determined in each case by subtracting the two scores of both time points.
  
  
  RESULTS
  All four categories show fair interobserver reliability when using plain radiographs. MDCT showed no improvement, the reliability was poor for the categories "bridging callus present" and "persistent fracture line", and fair for "healed" and "surgery advised". In none of the cases, MDCT led to a change of management from nonoperative to operative treatment or vice versa. For 18 out of 32 cases, the treatment plans did not alter. In seven cases MDCT led to operative treatment while on X-ray the treatment plan was undecided.
  
  
  CONCLUSIONS
  In this study, the interobserver reliability of MDCT scan is not greater than conventional radiographs for determining non-union. However, a MDCT scan did lead to a more invasive approach in equivocal cases. Therefore a MDCT is only recommended for making treatment strategies in those cases.
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Joint Research Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
authors.forename: Ydo V
authors.initials: YV
authors.lastname: Kleinlugtenbelt
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Joint Research Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
authors.forename: Vanessa A B
authors.initials: VA
authors.lastname: Scholtes
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Joint Research Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
authors.forename: Jay
authors.initials: J
authors.lastname: Toor
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Joint Research Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
authors.forename: Christian
authors.initials: C
authors.lastname: Amaechi
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Joint Research Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
authors.forename: Mario
authors.initials: M
authors.lastname: Maas
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Joint Research Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
authors.forename: Mohit
authors.initials: M
authors.lastname: Bhandari
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Joint Research Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
authors.forename: Rudolf W
authors.initials: RW
authors.lastname: Poolman
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Joint Research Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Kloen
keywords: Computed Tomography; Fracture; Non-union; Reliability