Radiographic diagnosis of scapholunate dissociation among intra-articular fractures of the distal radius

Interobserver reliability

Science of Variation Group

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Purpose: To evaluate the reliability and accuracy of diagnosis of scapholunate dissociation (SLD) among AO type C (compression articular) fractures of the distal radius. Methods: A total of 217 surgeons evaluated 21 sets of radiographs with type C fractures of the distal radius for which the status of the scapholunate interosseous ligament was established by preoperative 3-compartment computed tomographic arthrography with direct operative visualization of diagnosed SLD (reference standard). Observers were asked whether SLD was present, and if yes, whether they would recommend operative treatment. Diagnostic performance characteristics were calculated with respect to the reference standard. We assessed interobserver reliability using the Fleiss generalized kappa. Results: The interobserver agreement for radiographic diagnosis of SLD was moderate (κ = 0.44). Correct diagnosis for a given set of radiographs ranged from 8% to 98% (average, 79%) of observers. Diagnostic performance characteristics were: 69% sensitivity, 84% specificity, 84% accuracy, 68% positive predictive value, and 84% negative predictive value. Based on a prevalence of 5%, Bayes adjusted positive and negative predictive values were 18% and 98%, respectively. Raters recommended operative treatment in 74% to 100% of patients diagnosed with SLD. Conclusions: Radiographs are moderately reliable and are better at ruling out than ruling in SLD associated with type C fracture of the distal radius.

Original languageEnglish (US)
Pages (from-to)1685-1690
Number of pages6
JournalJournal of Hand Surgery
Volume38
Issue number9
DOIs
StatePublished - Sep 1 2013

Fingerprint

Intra-Articular Fractures
Radius Fractures
Compression Fractures
Arthrography
Ligaments
Joints
Sensitivity and Specificity
Therapeutics

Keywords

  • Interobserver reliability
  • distal radius intra-articular fracture
  • scapholunate injury

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Radiographic diagnosis of scapholunate dissociation among intra-articular fractures of the distal radius : Interobserver reliability. / Science of Variation Group.

In: Journal of Hand Surgery, Vol. 38, No. 9, 01.09.2013, p. 1685-1690.

Research output: Contribution to journalArticle

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title = "Radiographic diagnosis of scapholunate dissociation among intra-articular fractures of the distal radius: Interobserver reliability",
abstract = "Purpose: To evaluate the reliability and accuracy of diagnosis of scapholunate dissociation (SLD) among AO type C (compression articular) fractures of the distal radius. Methods: A total of 217 surgeons evaluated 21 sets of radiographs with type C fractures of the distal radius for which the status of the scapholunate interosseous ligament was established by preoperative 3-compartment computed tomographic arthrography with direct operative visualization of diagnosed SLD (reference standard). Observers were asked whether SLD was present, and if yes, whether they would recommend operative treatment. Diagnostic performance characteristics were calculated with respect to the reference standard. We assessed interobserver reliability using the Fleiss generalized kappa. Results: The interobserver agreement for radiographic diagnosis of SLD was moderate (κ = 0.44). Correct diagnosis for a given set of radiographs ranged from 8{\%} to 98{\%} (average, 79{\%}) of observers. Diagnostic performance characteristics were: 69{\%} sensitivity, 84{\%} specificity, 84{\%} accuracy, 68{\%} positive predictive value, and 84{\%} negative predictive value. Based on a prevalence of 5{\%}, Bayes adjusted positive and negative predictive values were 18{\%} and 98{\%}, respectively. Raters recommended operative treatment in 74{\%} to 100{\%} of patients diagnosed with SLD. Conclusions: Radiographs are moderately reliable and are better at ruling out than ruling in SLD associated with type C fracture of the distal radius.",
keywords = "Interobserver reliability, distal radius intra-articular fracture, scapholunate injury",
author = "{Science of Variation Group} and Gertraud Gradl and Valentin Neuhaus and Thomas Fuchsberger and Guitton, {Thierry G.} and Prommersberger, {Karl Josef} and David Ring and Wahegaonkar, {Abhijeet L.} and Shafritz, {Adam B.} and Garcia, {Aida E.} and Caputo, {Andrew E.} and Terrono, {Andrew L.} and Spoor, {Andy B.} and Anica Eschler and Vochteloo, {Anne J.H.} and Annechien Beumer and Antonio Barquet and Anze Kristan and {Van Der Zwan}, {Arnard L.} and Arne Berner and Asif Ilyas and Axel Jubel and Ben Sutker and Nolan, {Betsy M.} and Brad Petrisor and Cross, {Brian J.} and Wills, {Brian P.D.} and Barreto, {Camilo J.R.} and Fernandes, {Carlos H.} and Carrie Swigart and Charalampos Zalavras and Goldfarb, {Charles A.} and Charles Cassidy and Charles Eaton and Chris Wilson and Cheng, {Christine J.} and Wall, {Christopher J.} and Walsh, {Christopher J.} and Jones, {Christopher M.} and Christos Garnavos and Colby Young and Cyrus Klostermann and Kirkpatrick, {D. Kay} and Osei, {Daniel A.} and Rikli, {Daniel A.} and Wascher, {Daniel C.} and Daniel Polatsch and Silva, {Dario Mejia} and Nelson, {David L.} and Kalainov, {David M.} and Streubel, {Philipp N}",
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T1 - Radiographic diagnosis of scapholunate dissociation among intra-articular fractures of the distal radius

T2 - Interobserver reliability

AU - Science of Variation Group

AU - Gradl, Gertraud

AU - Neuhaus, Valentin

AU - Fuchsberger, Thomas

AU - Guitton, Thierry G.

AU - Prommersberger, Karl Josef

AU - Ring, David

AU - Wahegaonkar, Abhijeet L.

AU - Shafritz, Adam B.

AU - Garcia, Aida E.

AU - Caputo, Andrew E.

AU - Terrono, Andrew L.

AU - Spoor, Andy B.

AU - Eschler, Anica

AU - Vochteloo, Anne J.H.

AU - Beumer, Annechien

AU - Barquet, Antonio

AU - Kristan, Anze

AU - Van Der Zwan, Arnard L.

AU - Berner, Arne

AU - Ilyas, Asif

AU - Jubel, Axel

AU - Sutker, Ben

AU - Nolan, Betsy M.

AU - Petrisor, Brad

AU - Cross, Brian J.

AU - Wills, Brian P.D.

AU - Barreto, Camilo J.R.

AU - Fernandes, Carlos H.

AU - Swigart, Carrie

AU - Zalavras, Charalampos

AU - Goldfarb, Charles A.

AU - Cassidy, Charles

AU - Eaton, Charles

AU - Wilson, Chris

AU - Cheng, Christine J.

AU - Wall, Christopher J.

AU - Walsh, Christopher J.

AU - Jones, Christopher M.

AU - Garnavos, Christos

AU - Young, Colby

AU - Klostermann, Cyrus

AU - Kirkpatrick, D. Kay

AU - Osei, Daniel A.

AU - Rikli, Daniel A.

AU - Wascher, Daniel C.

AU - Polatsch, Daniel

AU - Silva, Dario Mejia

AU - Nelson, David L.

AU - Kalainov, David M.

AU - Streubel, Philipp N

PY - 2013/9/1

Y1 - 2013/9/1

N2 - Purpose: To evaluate the reliability and accuracy of diagnosis of scapholunate dissociation (SLD) among AO type C (compression articular) fractures of the distal radius. Methods: A total of 217 surgeons evaluated 21 sets of radiographs with type C fractures of the distal radius for which the status of the scapholunate interosseous ligament was established by preoperative 3-compartment computed tomographic arthrography with direct operative visualization of diagnosed SLD (reference standard). Observers were asked whether SLD was present, and if yes, whether they would recommend operative treatment. Diagnostic performance characteristics were calculated with respect to the reference standard. We assessed interobserver reliability using the Fleiss generalized kappa. Results: The interobserver agreement for radiographic diagnosis of SLD was moderate (κ = 0.44). Correct diagnosis for a given set of radiographs ranged from 8% to 98% (average, 79%) of observers. Diagnostic performance characteristics were: 69% sensitivity, 84% specificity, 84% accuracy, 68% positive predictive value, and 84% negative predictive value. Based on a prevalence of 5%, Bayes adjusted positive and negative predictive values were 18% and 98%, respectively. Raters recommended operative treatment in 74% to 100% of patients diagnosed with SLD. Conclusions: Radiographs are moderately reliable and are better at ruling out than ruling in SLD associated with type C fracture of the distal radius.

AB - Purpose: To evaluate the reliability and accuracy of diagnosis of scapholunate dissociation (SLD) among AO type C (compression articular) fractures of the distal radius. Methods: A total of 217 surgeons evaluated 21 sets of radiographs with type C fractures of the distal radius for which the status of the scapholunate interosseous ligament was established by preoperative 3-compartment computed tomographic arthrography with direct operative visualization of diagnosed SLD (reference standard). Observers were asked whether SLD was present, and if yes, whether they would recommend operative treatment. Diagnostic performance characteristics were calculated with respect to the reference standard. We assessed interobserver reliability using the Fleiss generalized kappa. Results: The interobserver agreement for radiographic diagnosis of SLD was moderate (κ = 0.44). Correct diagnosis for a given set of radiographs ranged from 8% to 98% (average, 79%) of observers. Diagnostic performance characteristics were: 69% sensitivity, 84% specificity, 84% accuracy, 68% positive predictive value, and 84% negative predictive value. Based on a prevalence of 5%, Bayes adjusted positive and negative predictive values were 18% and 98%, respectively. Raters recommended operative treatment in 74% to 100% of patients diagnosed with SLD. Conclusions: Radiographs are moderately reliable and are better at ruling out than ruling in SLD associated with type C fracture of the distal radius.

KW - Interobserver reliability

KW - distal radius intra-articular fracture

KW - scapholunate injury

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U2 - 10.1016/j.jhsa.2013.05.039

DO - 10.1016/j.jhsa.2013.05.039

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VL - 38

SP - 1685

EP - 1690

JO - Journal of Hand Surgery

JF - Journal of Hand Surgery

SN - 0363-5023

IS - 9

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