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J Wrist Surg 2018; 07(04): 350-354
DOI: 10.1055/s-0038-1641716
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Interobserver Variability of the Diagnosis of Scaphoid Proximal Pole Fractures

Reinier B. Beks
1   Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Tessa Drijkoningen
1   Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Femke Claessen
1   Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
,
Thierry G. Guitton
2   Department of Plastic Surgery, University Medical Center Groningen, Groningen, The Netherlands
,
David Ring
3   Department of Comprehensive Care, Dell Medical School, The University of Texas at Austin, Austin, Texas
,
Science of Variation Group › Author Affiliations Funding None.
Further Information

Publication History

28 July 2017

06 March 2018

Publication Date:
10 April 2018 (online)

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Abstract

Purpose Fractures of the proximal pole of the scaphoid are prone to adverse outcomes such as nonunion and avascular necrosis. Distinction of scaphoid proximal pole fractures from waist fractures is important for management but it is unclear if the distinction is reliable.

Methods A consecutive series of 29 scaphoid fractures from one tertiary hospital was collected consisting of 5 scaphoid proximal pole and 24 scaphoid waist fractures. Fifty-seven members of the Science of Variation Group (SOVG) were randomized to diagnose fracture location and displacement by using radiographs alone or radiographs and a computed tomography (CT) scan.

Results Observers reviewing radiographs alone and observers reviewing radiographs and CT scans both had substantial agreement on fracture location (κ = 0.82 and κ = 0.80, respectively; p = 0.54). Both groups had only fair agreement on fracture displacement (κ = 0.28 and κ = 0.35, respectively; p = 0.029).

Conclusion Proximal pole fractures are sufficiently distinct from proximal waist fractures that CT does not improve reliability of diagnosis.

Level of Evidence Level IV interobserver reliability case-control study.

Keywords

scaphoid fracture - radiograph - CT scan - interobserver study

Science of Variation Group

H.L. Kimball, F.T.D. Kaplan, J. Isaacs, S. Dodds, R.S. Page, R. de Bedout, C. Ekholm, P. Muhl, A. Markiewitz, P. Hahn, J. C. Fanuele, J.M. Patiño, M. Calcagni, L. Katolik, N.E.L. Felipe, G.J. Bayne, M.J. Richard, A.B. Shafritz, C. Lomita, E. Hofmeister, J.M. Erickson, M. Baskies, K. Erol, F. Verstreken, H.B. Bamberger, J.A. Izzi, C.J.R. Barreto, M. Nancollas, K.J. Prommersberger, R.S. Gilbert, C. Rodner, S. Kakar, C. Swigart, D. Polatsch, B.F. Hearon, F. Walter, S.M. Jacoby, G. DeSilva, D.M. McKee, J.T. Capo, M.J. Palmer, M. Richardson, P.J. Evans, S.A. Kennedy, T. Baxamusa, C.M. Jones, M. Rizzo, D.L. Nelson, A.J.H. Vochteloo, B.P.D. Wills, S.F. Duncan, N.M. Akabudike, J. Sandoval, L. Weiss, C.L. Moreno-Serrano, D. Eygendaal, and L.B. Lane.


Note

This work was performed at the Orthopedic Hand and Upper Extremity Service and Department of Behavioral Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. The Massachusetts General Hospital Institutional Review Board has approved the human protocol for this investigation under number 2009P001019.