Computed Tomography vs Standard Radiograph in Preoperative Planning of Distal Radius Fractures with Articular Involvement

Abstract

Introduction: Distal radius fractures with articular involvement are more likely to require surgical management. Treatment decisions are based on parameters which are obtained from plain radiographs. This study aims to determine the differences between computed tomography and standard radiographs in the preoperative planning of distal radius fractures with articular involvement. This was performed by measuring the intraobserver and interobserver reliability between three systems used to interpret the main fracture characteristics and two treatment decisions. Materials and methods: Forty-three cases of distal radius fractures with articular involvement were included. Fracture displacement was measured using plain radiographic and computed tomography. Five orthopedic surgeons evaluate the images to determine the AO/OTA classification, the articular fragments, the biomechanical columns involved, and recommend a surgical approach and implant for fracture fixation. Results: An articular step-off was identified in 13 cases (30%) with the standard radiographs and in 22 (51%) cases with the computed tomography (p = 0.00). Interobserver variation for preoperative planning was slight when evaluated using the standard radiographs. Computed tomography improves reliability for AO/OTA classification and articular fragments but not for the biomechanical columns. Intraobserver variation for preoperative planning was slight to moderate for AO/OTA classification and slight to fair for identification of articular fragments and biomechanical columns. With regard to selection of the surgical approach, there was slight to moderate variation and, finally, for fracture fixation it was slight to fair. Conclusion: Information provided by conventional radiography and computed tomography are sufficiently different as to induce the surgeon to select different treatments for the same fracture.

Short-term results and complications of the operative treatment of the distal radius fracture AO2R3 C type, planned by using 3D-printed models. Prospective randomized control study

“…Furthermore, the evaluation of CT scans alone can lead to confusion by misunderstanding irrelevant "small" or clinically insignificant fragment displacement leading surgeons to plan unrealistic fixation. 28,29 We assume that our study presented X-rays and CT scans with carpal bones could provide less information about fracture personality, especially attention to the rotational dislocation of the fragments and implant selection and positioning. With 3D-printed models without carpal bones, surgeons could precisely evaluate the actual view of the articular joint from the inside and choose an appropriate surgical approach.…”

“…Furthermore, the evaluation of CT scans alone can lead to confusion by misunderstanding irrelevant “small” or clinically insignificant fragment displacement leading surgeons to plan unrealistic fixation. 28,29…”

Recent developments in X-ray diffraction/scattering computed tomography for materials science

“…Absorption-based XR-CT is a gold standard medical imaging technique that has been adopted worldwide. CT radiography offers a truer geometric representation of its subject than traditional planar radiographic projections do, which has made the method indispensable in scenarios where accurate visualization is necessary for delivering optimal clinical outcomes such as surgical planning, in particular orthopaedics [ 141 ] and neurosurgery. The early intentions to develop a quantitative form of XRD-CT for diagnostic radiology are evidenced in Harding, Kosanetzy and Neitzel's original paper on the method, which expressly illustrated the dissimilarity between fat, muscle, and bone XRD signals to demonstrate its eligibility for diffraction-based imaging [ 20 ].…”

Trends in the Utilization of Computed Tomography in Operative Treatment of Distal Radius Fractures

“… 13 , 14 , 15 , 16 The use of CT scans has been shown to increase the agreement in fracture classification and aid in the identification of intra-articular fracture lines. 17 , 18 , 19 , 20 , 21 These studies have surveyed surgeons and assessed both fracture classification and proposed treatment plans; however, it is less clear if the use of advanced imaging is associated with actual changes in surgical management. Furthermore, advanced imaging modalities (including CT scans) are increasingly used during emergency department visits related to fractures with unclear clinical benefits relative to cost.…”