Classification systems for distal radius fractures

Abstract

Background and purpose — The reliability of conventional radiography when classifying distal radius fractures (DRF) is fair to moderate. We investigated whether reliability increases when additional computed tomography scans (CT) are used.Patients and methods — In this prospective study, we performed pre- and postreduction posterior–anterior and lateral radiographs of 51 patients presenting with a displaced DRF. The case was included when there was a (questionable) indication for surgical treatment and an additional CT was conducted within 5 days. 4 observers assessed the cases using the Frykman, Fernández, Universal, and AO classification systems. The first 2 assessments were performed using conventional radiography alone; the following 2 assessments were performed with an additional CT. We used the intraclass correlation coefficient (ICC) to evaluate reliability. The CT was used as a reference standard to determine the accuracy.Results — The intraobserver ICC for conventional radiography alone versus radiography and an additional CT was: Frykman 0.57 vs. 0.51; Fernández 0.53 vs. 0.66; Universal 0.57 vs. 0.64; AO 0.59 vs. 0.71. The interobserver ICC was: Frykman: 0.45 vs. 0.28; Fernández: 0.38 vs. 0.44; Universal: 0.32 vs. 0.43; AO: 0.46 vs. 0.40.Interpretation — The intraobserver reliability of the classification systems was fair but improved when an additional CT was used, except for the Frykman classification. The interobserver reliability ranged from poor to fair and did not improve when using an additional CT. Additional CT scanning has implications for the accuracy of scoring the fracture types, especially for simple fracture types.

Standard radiographic assessments of distal radius fractures miss involvement of the distal radioulnar joint: a diagnostic study

“…Correct identification of fracture extensions into the DRUJ therefore did only negligibly improve with clinical experience and were missed in 61.7 to 66.6% of the cases. Generally, sigmoid notch involvement was found in 84.3% of all scanned fractures, which is similar or slightly higher than numbers from previous reports [4,10,16,22]. Generally, involvement of the sigmoid notch was best identified in axial CT reconstructions, as has been noted by other authors [23].…”

“…Amongst the most common classification systems of distal radius fractures, however, only the Frykman classification [8] takes into account the involvement of the distal radio-ulnar joint. Few studies with limited patient numbers have compared distal radius fracture extensions using conventional radiographs and computer tomography (CT) [9][10][11], all of which found an underestimation of distal radio-ulnar joint involvement based on plain radiographs.…”

Evaluation of Factors Driving Cost Variation for Distal Radius Fracture Open Reduction Internal Fixation

“…2 Utilizing CPT codes as a surrogate for fracture severity also poses as a limitation. Inter-rater reliability in assessing the number of articular parts is limited, 19,20 surgeons may charge for a more complex CPT code even if additional fragments are minor or nondisplaced, and fractures with 3 or more parts, corresponding with CPT 25609, likely represents a wide spectrum of injury ranging from minimally-displaced intra articular fractures to those with severe comminution and displacement. For certain complex fractures, multiple surgical approaches, multiple plates, a greater number of screws, and the addition of a dorsal spanning plate or supplemental pinning may be required to achieve an adequate reduction and fixation – these factors, not captured by CPT coding, may influence the cost of surgery.…”

Involvement of the palmar lunate facet in intra-articular distal radius fractures

“…If fractures were classified on plain radiographs, intra-articular extensions can be missed and fracture severity underestimated. It has been shown that intraobserver reliability of classification systems is better with additional computed tomography (CT) [8,9]. Therefore, in the present study, three-dimensional (3D) CT scans were used to classify intra-articular fractures more accurately.…”