Does computed tomography change our observation and management of fracture non-unions?

COAST Group

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: The purpose of this study was to determine whether Multi-Detector Computed Tomography (MDCT) in addition to plain radiographs influences radiologists' and orthopedic surgeons' diagnosis and treatment plans for delayed unions and non-unions. Methods: A retrospective database of 32 non-unions was reviewed by 20 observers. On a scale of 1 to 5, observers rated on X-Ray and a subsequent Multi Detector Helical Computer Tomography (MDCT) scan was performed to determine the following categories: "healed", "bridging callus present", "persistent fracture line" or "surgery advised". Interobserver reliability in each category was calculated using the Interclass Correlation Coefficient (ICC). The influence of the MDCT scan on the raters' observations was determined in each case by subtracting the two scores of both time points. Results: All four categories show fair interobserver reliability when using plain radiographs. MDCT showed no improvement, the reliability was poor for the categories "bridging callus present" and "persistent fracture line", and fair for "healed" and "surgery advised". In none of the cases, MDCT led to a change of management from nonoperative to operative treatment or vice versa. For 18 out of 32 cases, the treatment plans did not alter. In seven cases MDCT led to operative treatment while on X-ray the treatment plan was undecided. Conclusion: In this study, the interobserver reliability of MDCT scan is not greater than conventional radiographs for determining non-union. However, a MDCT scan did lead to a more invasive approach in equivocal cases. Therefore a MDCT is only recommended for making treatment strategies in those cases.

Original languageEnglish (US)
Pages (from-to)337-342
Number of pages6
JournalArchives of Bone and Joint Surgery
Volume4
Issue number4
StatePublished - 2016

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Tomography
Observation
Bony Callus
X-Rays
Therapeutics
Databases

Keywords

  • Computed tomography
  • Fracture
  • Non-union
  • Reliability

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Does computed tomography change our observation and management of fracture non-unions? / COAST Group.

In: Archives of Bone and Joint Surgery, Vol. 4, No. 4, 2016, p. 337-342.

Research output: Contribution to journalArticle

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title = "Does computed tomography change our observation and management of fracture non-unions?",
abstract = "Background: The purpose of this study was to determine whether Multi-Detector Computed Tomography (MDCT) in addition to plain radiographs influences radiologists' and orthopedic surgeons' diagnosis and treatment plans for delayed unions and non-unions. Methods: A retrospective database of 32 non-unions was reviewed by 20 observers. On a scale of 1 to 5, observers rated on X-Ray and a subsequent Multi Detector Helical Computer Tomography (MDCT) scan was performed to determine the following categories: {"}healed{"}, {"}bridging callus present{"}, {"}persistent fracture line{"} or {"}surgery advised{"}. Interobserver reliability in each category was calculated using the Interclass Correlation Coefficient (ICC). The influence of the MDCT scan on the raters' observations was determined in each case by subtracting the two scores of both time points. Results: All four categories show fair interobserver reliability when using plain radiographs. MDCT showed no improvement, the reliability was poor for the categories {"}bridging callus present{"} and {"}persistent fracture line{"}, and fair for {"}healed{"} and {"}surgery advised{"}. In none of the cases, MDCT led to a change of management from nonoperative to operative treatment or vice versa. For 18 out of 32 cases, the treatment plans did not alter. In seven cases MDCT led to operative treatment while on X-ray the treatment plan was undecided. Conclusion: In this study, the interobserver reliability of MDCT scan is not greater than conventional radiographs for determining non-union. However, a MDCT scan did lead to a more invasive approach in equivocal cases. Therefore a MDCT is only recommended for making treatment strategies in those cases.",
keywords = "Computed tomography, Fracture, Non-union, Reliability",
author = "{COAST Group} and Kleinlugtenbelt, {Ydo V.} and Scholtes, {Vanessa A B} and Jay Toor and Christian Amaechi and Mario Maas and Mohit Bhandari and Poolman, {Rudolf W.} and Peter Kloen and Bob Zura and Sumito Kawamura and Crist, {Brett D.} and David Ring and Rocca, {Gregory J Della} and Feibel, {Robert J.} and Jeray, {Kyle J.} and Page, {Prof Richard} and Levin, {Paul E.} and B. McCormack and Rodrigo Pesantez and Charalampos Zalavras and M. Prayson and Brink, {Peter R G} and Schmidt, {Andrew H.} and Christopher Allan and Greenberg, {Jeffrey A.} and A. Barquet",
year = "2016",
language = "English (US)",
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T1 - Does computed tomography change our observation and management of fracture non-unions?

AU - COAST Group

AU - Kleinlugtenbelt, Ydo V.

AU - Scholtes, Vanessa A B

AU - Toor, Jay

AU - Amaechi, Christian

AU - Maas, Mario

AU - Bhandari, Mohit

AU - Poolman, Rudolf W.

AU - Kloen, Peter

AU - Zura, Bob

AU - Kawamura, Sumito

AU - Crist, Brett D.

AU - Ring, David

AU - Rocca, Gregory J Della

AU - Feibel, Robert J.

AU - Jeray, Kyle J.

AU - Page, Prof Richard

AU - Levin, Paul E.

AU - McCormack, B.

AU - Pesantez, Rodrigo

AU - Zalavras, Charalampos

AU - Prayson, M.

AU - Brink, Peter R G

AU - Schmidt, Andrew H.

AU - Allan, Christopher

AU - Greenberg, Jeffrey A.

AU - Barquet, A.

PY - 2016

Y1 - 2016

N2 - Background: The purpose of this study was to determine whether Multi-Detector Computed Tomography (MDCT) in addition to plain radiographs influences radiologists' and orthopedic surgeons' diagnosis and treatment plans for delayed unions and non-unions. Methods: A retrospective database of 32 non-unions was reviewed by 20 observers. On a scale of 1 to 5, observers rated on X-Ray and a subsequent Multi Detector Helical Computer Tomography (MDCT) scan was performed to determine the following categories: "healed", "bridging callus present", "persistent fracture line" or "surgery advised". Interobserver reliability in each category was calculated using the Interclass Correlation Coefficient (ICC). The influence of the MDCT scan on the raters' observations was determined in each case by subtracting the two scores of both time points. Results: All four categories show fair interobserver reliability when using plain radiographs. MDCT showed no improvement, the reliability was poor for the categories "bridging callus present" and "persistent fracture line", and fair for "healed" and "surgery advised". In none of the cases, MDCT led to a change of management from nonoperative to operative treatment or vice versa. For 18 out of 32 cases, the treatment plans did not alter. In seven cases MDCT led to operative treatment while on X-ray the treatment plan was undecided. Conclusion: In this study, the interobserver reliability of MDCT scan is not greater than conventional radiographs for determining non-union. However, a MDCT scan did lead to a more invasive approach in equivocal cases. Therefore a MDCT is only recommended for making treatment strategies in those cases.

AB - Background: The purpose of this study was to determine whether Multi-Detector Computed Tomography (MDCT) in addition to plain radiographs influences radiologists' and orthopedic surgeons' diagnosis and treatment plans for delayed unions and non-unions. Methods: A retrospective database of 32 non-unions was reviewed by 20 observers. On a scale of 1 to 5, observers rated on X-Ray and a subsequent Multi Detector Helical Computer Tomography (MDCT) scan was performed to determine the following categories: "healed", "bridging callus present", "persistent fracture line" or "surgery advised". Interobserver reliability in each category was calculated using the Interclass Correlation Coefficient (ICC). The influence of the MDCT scan on the raters' observations was determined in each case by subtracting the two scores of both time points. Results: All four categories show fair interobserver reliability when using plain radiographs. MDCT showed no improvement, the reliability was poor for the categories "bridging callus present" and "persistent fracture line", and fair for "healed" and "surgery advised". In none of the cases, MDCT led to a change of management from nonoperative to operative treatment or vice versa. For 18 out of 32 cases, the treatment plans did not alter. In seven cases MDCT led to operative treatment while on X-ray the treatment plan was undecided. Conclusion: In this study, the interobserver reliability of MDCT scan is not greater than conventional radiographs for determining non-union. However, a MDCT scan did lead to a more invasive approach in equivocal cases. Therefore a MDCT is only recommended for making treatment strategies in those cases.

KW - Computed tomography

KW - Fracture

KW - Non-union

KW - Reliability

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