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J Hand Microsurg 2014; 06(01): 13-17
DOI: 10.1007/s12593-013-0107-1
Original Article
Thieme Medical and Scientific Publishers Private Ltd.

Diagnostic Accuracy of Two-Dimensional and Three-Dimensional Imaging and Modeling of Radial Head Fractures

Thierry G. Guitton
1   Department of Orthopaedic Surgery, Academic Medical Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
,
Kim Brouwer
2   Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Suite 2100 55 Fruit Street, Boston, MA, 02114, USA   eMail: dring@partners.org
,
Anneluuk L.C. Lindenhovius
1   Department of Orthopaedic Surgery, Academic Medical Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
,
George Dyer
3   Orthopedic Surgery-Brigham & Women’s Hospital, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA, USA
,
David Zurakowski
4   Departments of Anesthesiology and Surgery, Children’s Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
,
Chaitanya S. Mudgal
2   Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Suite 2100 55 Fruit Street, Boston, MA, 02114, USA   eMail: dring@partners.org
,
David C. Ring
2   Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Suite 2100 55 Fruit Street, Boston, MA, 02114, USA   eMail: dring@partners.org
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Publikationsverlauf

14. April 2013

28. Oktober 2013

Publikationsdatum:
13. September 2016 (online)

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Abstract

To tests the hypothesis that classification and characterization of fractures of the radial head is more accurate with 3D than 2D computed tomography images and radiographs, using a prospective study design with intraoperative inspection as the reference standard. Treating surgeons and first assistants completed a questionnaire assigning a fracture type according to the Broberg and Morrey modification of Mason’s classification, evaluating selected fracture characteristics, and electing preferred management based upon radiographs and 2D images alone; then adding 3D-CT; then 3D printed physical models; and finally intra-operative visualization. The addition of the 3D CT and physical models improved the sensitivity for fracture line separating the entire head from the neck, comminution of the radial neck, fracture involving the articular surface, articular fracture gap greater than 2 mm, impacted fracture fragments, greater than 3 articular fragments, and articular fragments judged too small to repair. There were no significant differences in diagnostic performance with the addition of 3D models. The addition of 3D CT and models improved the reliability of Broberg and Morrey classification. We conclude that 3DCT and 3D physical modeling provide more accurate fracture classification and characterization of fracture of the radial head with less proposed variability in treatment. We did not demonstrate a clear advantage for modeling over 3DCT reconstructions.

Level of Evidence: Diagnostic, Level I

Keywords

Three-dimensional computed tomography - Modeling - Radial head fracture - Reliability - Accuracy

Electronic supplementary material The online version of this article (doi:10.1007/s12593-013-0107-1) contains supplementary material, which is available to authorized users.


 

  • References

  • 1 Borrelli J Jr, Goldfarb C, Catalano L, Evanoff BA. Assessment of articular fragment displacement in acetabular fractures: a comparison of computerized tomography and plain radiographs. J Orthop Trauma 2002; 16 (7) 449-456 discussion 56-7
    CrossrefPubMedSuche in Google Scholar
  • 2 Castagno AA, Shuman WP, Kilcoyne RF, Haynor DR, Morris ME, Matsen FA. Complex fractures of the proximal humerus: role of CT in treatment. Radiology 1987; 165 (3) 759-762
    CrossrefPubMedSuche in Google Scholar
  • 3 Edelson G, Kelly I, Vigder F, Reis ND. A three-dimensional classification for fractures of the proximal humerus. J Bone Joint Surg Br 2004; 86 (3) 413-425
    CrossrefPubMedSuche in Google Scholar
  • 4 Katz MA, Beredjiklian PK, Bozentka DJ, Steinberg DR. Computed tomography scanning of intra-articular distal radius fractures: does it influence treatment?. J Hand Surg [Am] 2001; 26 (3) 415-421
    CrossrefPubMedSuche in Google Scholar
  • 5 Kilcoyne RF, Shuman WP, Matsen FA, 3rd Morris M, Rockwood CA. The Neer classification of displaced proximal humeral fractures: spectrum of findings on plain radiographs and CT scans. AJR Am J Roentgenol 1990; 154 (5) 1029-1033
    CrossrefPubMedSuche in Google Scholar
  • 6 Kuhlman JE, Fishman EK, Ney DR, Magid D. Two-and threedimensional imaging of the painful shoulder. Orthop Rev 1989; 18 (11) 1201-1208
    PubMedSuche in Google Scholar
  • 7 Siebenrock KA, Gerber C. The reproducibility of classification of fractures of the proximal end of the humerus. J Bone Joint Surg Am 1993; 75 (12) 1751-1755
    PubMedSuche in Google Scholar
  • 8 Smith RM. The classification of fractures. J Bone Joint Surg Br 2000; 82 (5) 625-626
    CrossrefPubMedSuche in Google Scholar
  • 9 Lindenhovius A, Karanicolas PJ, Bhandari M, van Dijk N, Ring D. Interobserver reliability of coronoid fracture classification: two-dimensional versus three-dimensional computed tomography. J Hand Surg [Am] 2009; 34 (9) 1640-1646
    CrossrefPubMedSuche in Google Scholar
  • 10 Jupiter JB, Ruder J, Roth DA. Computer-generated bone models in the planning of osteotomy of multidirectional distal radius malunions. JHand Surg [Am] 1992; 17 (3) 406-415
    PubMedSuche in Google Scholar
  • 11 Murase T, Oka K, Moritomo H, Goto A, Yoshikawa H, Sugamoto K. Three-dimensional corrective osteotomy of malunited fractures of the upper extremity with use of a computer simulation system. J Bone Joint Surg Am 2008; 90 (11) 2375-2389
    CrossrefPubMedSuche in Google Scholar
  • 12 Broberg MA, Morrey BF. Results of treatment of fracture-dislocations of the elbow. Clin Orthop Relat Res 1987; 216: 109-119
    PubMedSuche in Google Scholar
  • 13 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33 (1) 159-174
    CrossrefPubMedSuche in Google Scholar
  • 14 Harrell F. Regression modeling strategies with applications to linear models, logistic regression, and survival analysis. Springer, New York; 2001: 331-342
  • 15 Kocher MS, Zurakowski D. Clinical epidemiology and biostatistics: a primer for orthopaedic surgeons. J Bone Joint Surg Am 2004; 86-A (3) 607-620
    PubMedSuche in Google Scholar
  • 16 Doornberg J, Lindenhovius A, Kloen P, van Dijk CN, Zurakowski D, Ring D. Two and three-dimensional computed tomography for the classification and management of distal humeral fractures. Evaluation of reliability and diagnostic accuracy. J Bone Joint Surg Am 2006; 88 (8) 1795-1801
    CrossrefPubMedSuche in Google Scholar
  • 17 Harness NG, Ring D, Zurakowski D, Harris GJ, Jupiter JB. The influence of three-dimensional computed tomography reconstructions on the characterization and treatment of distal radial fractures. J Bone Joint Surg Am 2006; 88 (6) 1315-1323
    CrossrefPubMedSuche in Google Scholar
  • 18 Guitton TG, Ring D Science of Variation Group Interobserver reliability of radial head fracture classification: two-dimensional compared with three-dimensional CT. J Bone Joint Surg Am 2011; 93 (21) 2015-2021
    CrossrefPubMedSuche in Google Scholar
  • 19 Rosset A, Spadola L, Ratib O. OsiriX: An Open-Source Software for Navigating in Multidimensional DICOM Images. Journal of Digital Imaging 2004; 17 (3) 205-16
    CrossrefPubMedSuche in Google Scholar
  • 20 Doornberg J, Elsner A, Kloen P, Marti RK, van Dijk CN, Ring D. Apparently isolated partial articular fractures of the radial head: prevalence and reliability of radiographically diagnosed displacement. J Should Elbow Surg 2007; 16 (5) 603-608
    CrossrefPubMedSuche in Google Scholar
  • 21 Matsunaga FT, Tamaoki MJ, Cordeiro EF, Uehara A, Ikawa MH, Matsumoto MH et al Are classifications of proximal radius fractures reproducible?. BMC Musculoskelet Disord 2009; 10: 120
    CrossrefPubMedSuche in Google Scholar
  • 22 Morgan SJ, Groshen SL, Itamura JM, Shankwiler J, Brien WW, Kuschner SH. Reliability evaluation of classifying radial head fractures by the system of Mason. Bull Hosp Jt Dis 1997; 56 (2) 95-98
    PubMedSuche in Google Scholar
  • 23 Sheps DM, Kiefer KR, Boorman RS, Donaghy J, Lalani A, Walker R et al The interobserver reliability of classification systems for radial head fractures: the Hotchkiss modification of the Mason classification and the AO classification systems. Can J Surg 2009; 52 (4) 277-282
    PubMedSuche in Google Scholar