Intra- and inter-observer agreement in distal radius fracture dislocation measurement of casting position
DOI:
https://doi.org/10.2340/17453674.2023.13707Keywords:
conservative treatment, distal radius fracture, population-based study, x-rayAbstract
Background and purpose: Most displaced distal radius fractures (DRF) are treated nonoperatively, with reduction and immobilization in a cast. Studies assessing intra- or inter-observer agreement on radiologic measurements of casting position have not been published, which was the aim of our study.
Patients and methods: Our study is based on the Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) study. All detected DRFs during the OSTPRE follow-up were retrieved and based on sample size calculations 50 fractures were randomly selected for the study. 5 independent reviewers measured dislocation parameters and wrist position in a cast from the radiographs. A linear mixed model was used to estimate the concordance correlation coefficient (CCC) and total deviance index (TDI) that were used to evaluate intra- and inter-observer agreement. We used Kappa values to determine intra- and inter-rater agreement on radiographically acceptable reduction of the DRF. Limits of acceptable position were those defined by Finnish Current Care Guidelines.
Results: For radial inclination, radial shortening, and dorsal/volar tilt, intra- and inter-observer correlations were high (CCC > 0.76). In addition, measurements of wrist angle in a splint had high correlations (CCC > 0.78), whereas measurement of intra-articular gap and step had poor correlations (CCC < 0.52). The Kappa value for overall agreement on the radiographically acceptable position of the DRF was modest (0.59).
Conclusion: Intra- and inter-observer repeatability of casting position of radial inclination, radial shortening, and dorsal/volar tilt were high whereas intra-articular gap and step had poor correlations.
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Copyright (c) 2023 Katriina Paasikallio, Reijo Sund, Simo Miettinen, Sonja Kauranen, Hannu Sorsa, Heikki Kröger, Joonas Sirola
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