Interobserver Reliability in Imaging-Based Fracture Union Assessment-Two Systematic Reviews.

Objectives: (A) To investigate the specialty of observers involved in imaging-based assessment of bone fracture union in recent orthopaedic trials and (B) to provide a general overview of observer differences (in terms of interobserver reliability) in radiologic fracture union assessment that have been reported between surgeons and radiologists.

Data Sources: Two separate systematic reviews (A, B) of English-, German-, and French-language articles in MEDLINE and Embase databases using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were done, with the following time frames: (A) January 2016-August 2017 and (B) through November 2017.

Study Selection: (A) Clinical trials of surgical fracture treatment evaluating radiologic (non) union.

Reliability of Diagnosis of Partial Union of Scaphoid Waist Fractures on Computed Tomography.

Computed tomography (CT) is increasingly used not just to diagnose union but also to estimate the percentage of the fracture gap that is bridged by healing bone. This study tested the primary null hypothesis that there is no agreement between observers on the extent of union of a scaphoid waist fracture on CT. CT scans of 13 nondisplaced scaphoid waist fractures treated nonoperatively were rated by 145 observers.

Joint Space Narrowing in Patients With Pisotriquetral Osteoarthritis.

Background: Patients with suspected pisotriquetral osteoarthritis may show joint space narrowing. However, the extent of joint space narrowing and its deviation from the joint space width (JSW) in normal anatomy is unknown. In this pathoanatomic study, we therefore compared the JSW in the pisotriquetral joint between osteoarthritic patient wrists and healthy wrists.

Does a Comparison View Improve the Reliability of Staging Wrist Osteoarthritis?

Background: Radiological grading of wrist osteoarthritis associated with scaphoid nonunion advanced collapse (SNAC) can be difficult. A comparison radiograph of the contralateral healthy wrist and an educational training in the various SNAC stages may improve reliability. Our purposes were to evaluate the difference in the reliability: (1) between observers who rate SNAC wrists with and without a comparison radiograph; and (2) between observers who receive training prior to ratings and those who do not.

Is there a trend in CT scanning scaphoid nonunions for deformity assessment?-A systematic review.

Purpose: The effect of scaphoid nonunion deformity on wrist function is uncertain due to the lack of reliable imaging tools. Advanced three-dimensional (3-D) computed tomography (CT)-based imaging techniques may improve deformity assessment by using a mirrored image of the contralateral intact wrist as anatomic reference. The implementation of such techniques depends on the extent to which conventional CT is currently used in standard practice.

Observer Variability in Evaluating Pisotriquetral Osteoarthritis using Pisotriquetral View.

A pisotriquetral (semilateral) view of the wrist may improve the assessment of pisotriquetral osteoarthritis (OA), but its reliability and reproducibility are unclear. The purpose of this cross-sectional observer study was to investigate (1) the inter- and intraobserver agreement of evaluating pisotriquetral OA using pisotriquetral views with a special focus on sclerosis, joint space width (JSW) narrowing and osteophyte formation, and (2) the incidence of these latter radiographic features in patients suspected for pisotriquetral OA. Five independent observers rated independently at two different occasions 27 pisotriquetral views from patients treated for ulnar-sided wrist pain suspected for pisotriquetral OA requiring a pisiform resection.

Estimating Scaphoid Lengths Using Anatomical Measurements in the Wrist.

Purpose: In reconstructive surgery of scaphoid nonunions with humpback deformity, some surgeons recommend restoration of the normal scaphoid length whereas others overexpand the normal length to ensure carpal realignment and prevent late collapse. To be able to define overexpansion and investigate which levels of overexpansion yield optimal clinical results, a precise method for estimating the original scaphoid length is required. The purpose of this anatomic study was to investigate the precision of estimating normal scaphoid lengths based on intact adjacent bone dimensions, compared with using the contralateral scaphoid length.

Validation of the contralateral side as reference for selecting radial head implant sizes.

Purpose: In arthroplasty of comminuted radial head fractures, the contralateral radial head diameter can be used as reference for implant selection. However, potential bilateral asymmetry may result in a mismatch of the implant with the native bone. Therefore, our purpose was to evaluate anatomical right-to-left differences of radial head diameters.

Factors Associated with Patient Delay in Scaphoid Nonunions.

Delay in seeking medical attention by patients, ─so-called patient delay, contributes to the relative high rate of delayed diagnosis and treatment in scaphoid nonunion cases. In this retrospective study we investigated the incidence of patients with a patient delay exceeding 6 months, thus by definition having an established nonunion. In addition to this, we investigated demographic, injury and patient related factors associated with this patient delay in scaphoid nonunion patients.

Three-Dimensional Assessment of Bilateral Symmetry of the Scaphoid: An Anatomic Study.

Preoperative 3D CT imaging techniques provide displacement analysis of the distal scaphoid fragment in 3D space, using the matched opposite scaphoid as reference. Its accuracy depends on the presence of anatomical bilateral symmetry, which has not been investigated yet using similar techniques. Our purpose was to investigate symmetry by comparing the relative positions of distal and proximal poles between sides.

Quantifying scaphoid malalignment based upon height-to-length ratios obtained by 3-dimensional computed tomography.

Purpose: To determine if 3-dimensional height-to-length (H/L) measurements including coronal plane assessment will improve malalignment detection of scaphoid fractures and to determine if more waist than proximal pole nonunions are malaligned.

Methods: Computed tomography scans of uninjured wrists (n = 74) were used to obtain 3-dimensional models of healthy scaphoids. These models were used to determine 95% normal ranges of the H/L ratio in standard sagittal and coronal planes in an automated fashion.

Quantitative 3-dimensional CT analyses of intramedullary headless screw fixation for metacarpal neck fractures.

Purpose: Fixation countersunk beneath the articular surface is well accepted for periarticular fractures. Limited open intramedullary headless compression screw (HCS) fixation offers clinical advantages over Kirschner wire and open techniques. We used quantitative 3-dimensional computed tomography to assess the articular starting point, surface area, and subchondral volumes used during HCS fixation of metacarpal neck fractures.

Patients lost to follow-up after metacarpal fractures.

Purpose: To determine factors associated with non-attendance at scheduled follow-up visits for treatment of metacarpal fractures, to improve subject retention in prospective investigations.

Methods: This study included adult patients with metacarpal fractures seen in an outpatient hand clinic between 2004 and 2009. We assessed a number of variables (demographic, social, and injury-specific) that might be associated with failure to return for follow-up.