AI Article Synopsis
- This study aimed to assess whether Multi-Detector Computed Tomography (MDCT) improves the diagnostic and treatment decisions of radiologists and orthopedic surgeons regarding delayed unions and non-unions compared to plain X-rays.
- A group of 20 observers evaluated a database of 32 non-union cases using both X-rays and MDCT, measuring reliability in categories like "healed" and "surgery advised," but found MDCT did not significantly enhance reliability.
- Although MDCT did not change many treatment plans from nonoperative to operative, it did lead to surgical decisions in some ambiguous cases, suggesting it could be beneficial in specific situations.
Article 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.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5100449 | PMC |
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