The interobserver reliability of the diagnosis and classification of scaphoid fractures using high-resolution peripheral quantitative CT

Abstract

Aims Besides conventional radiographs, the use of MRI, CT, and bone scintigraphy is frequent in the diagnosis of a fracture of the scaphoid. However, which techniques give the best results remain unknown. The investigation of a new imaging technique initially requires an analysis of its precision. The primary aim of this study was to investigate the interobserver agreement of high-resolution peripheral quantitative CT (HR-pQCT) in the diagnosis of a scaphoid fracture. A secondary aim was to investigate the interobserver agreement for the presence of other fractures and for the classification of scaphoid fracture. Methods Two radiologists and two orthopaedic trauma surgeons evaluated HR-pQCT scans of 31 patients with a clinically-suspected scaphoid fracture. The observers were asked to determine the presence of a scaphoid or other fracture and to classify the scaphoid fracture based on the Herbert classification system. Fleiss kappa statistics were used to calculate the interobserver agreement for the diagnosis of a fracture. Intraclass correlation coefficients (ICCs) were used to assess the agreement for the classification of scaphoid fracture. Results A total of nine (29%) scaphoid fractures and 12 (39%) other fractures were diagnosed in 20 patients (65%) using HR-pQCT across the four observers. The interobserver agreement was 91% for the identification of a scaphoid fracture (95% confidence interval (CI) 0.76 to 1.00) and 80% for other fractures (95% CI 0.72 to 0.87). The mean ICC for the classification of a scaphoid fracture in the seven patients diagnosed with scaphoid fracture by all four observers was 73% (95% CI 0.42 to 0.94). Conclusion We conclude that the diagnosis of scaphoid and other fractures is reliable when using HR-pQCT in patients with a clinically-suspected fracture. Cite this article: Bone Joint J 2020;102-B(4):478–484.

The impact of motion induced artifacts in the evaluation of HR-pQCT scans of the scaphoid bone: an assessment of inter- and intraobserver variability and quantitative parameters

“…The CT also has a high specificity but a lower sensitivity; however, it is often preferred to the MRI as it is cheaper and more readily available (1,4,5). High-resolution peripheral quantitative computed tomography (HR-pQCT) represents an innovative option in detecting scaphoid fractures (6)(7)(8). Since the first results have only recently been published, its use is not yet widely established in this field.…”

Improved Detection of Scaphoid Fractures with High-Resolution Peripheral Quantitative CT Compared with Conventional CT

“…In previous studies, we found that HR-pQCT is a feasible and reliable technique for scaphoid fracture diagnosis 29 , with "almost perfect" interobserver agreement (Fleiss kappa, 0.91) according to the guidelines by Landis and Koch 35 . In the present Fig.…”

“…All HR-pQCT scans were evaluated by a musculoskeletal radiologist. In a previous study, the interobserver agreement for 4 observers (2 musculoskeletal radiologists and 2 orthopaedic trauma surgeons) was shown to be almost perfect regarding scaphoid fracture diagnosis with HR-pQCT in patients with a clinically suspected scaphoid fracture 35 . The observers evaluated each HR-pQCT scan independently and were asked to determine the presence of a scaphoid fracture or other fracture (i.e., distal radial, carpal, metacarpal) on the basis of their expert opinion and to classify the scaphoid fracture, if present, according to the Herbert classification system (Fig.…”

Prospective comparison of magnetic resonance imaging and computed tomography in diagnosing occult scaphoid fractures

“…Of trusts, 86.8% provided a second-line imaging 10–28 days after the initial injury; 63.9% used MRI and 27% used CT as second-line imaging (4). Conventional radiographs, MRI, CT, and bone scintigraphy are all frequently used in diagnosing SFs, but which technique provides the most accurate and cost-efficient results remains unclear (10). A systematic review, including 42 articles investigating 51 different diagnostic tools in 2507 patients, recently showed that MRI has the highest sensitivity and specificity for diagnosing SFs in comparison to CT, bone scintigraphy, and ultrasound (7).…”