The Journal of Bone and Joint Surgery (American). 2006;88:1315-1323.
doi:10.2106/JBJS.E.00686
© 2006 The Journal of Bone and Joint Surgery, Inc.
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The Influence of Three-Dimensional Computed Tomography Reconstructions on the Characterization and Treatment of Distal Radial Fractures

Neil G. Harness, MD1, David Ring, MD1, David Zurakowski, PhD2, Gordon J. Harris, PhD1 and Jesse B. Jupiter, MD1

1 Departments of Orthopaedic Surgery (N.G.H., D.R., and J.B.J.) and Radiology (G.J.H.), Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114. E-mail address for D. Ring: dring{at}partners.org
2 Department of Biostatistics, Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115

Investigation performed at Massachusetts General Hospital, Boston, Massachusetts

In support of their research for or preparation of this manuscript, one or more of the authors received grants or outside funding from the AO Foundation. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Computed tomography identifies important characteristics of distal radial fractures better than plain radiographs do. Our hypothesis was that three-dimensional computed tomography images would further increase the reliability and accuracy of radiographic characterization of distal radial fractures.

Methods: Four independent observers evaluated radiographic images of thirty intra-articular fractures of the distal part of the radius for the presence of a fracture line in the coronal plane, impacted central articular fragments, the presence of comminution (defined as more than three articular fragments), and the number of fracture fragments. A treatment was selected on the basis of the interpretation of the radiographic studies. Three rounds of evaluation were compared: (1) radiographs and two-dimensional computed tomography, (2) radiographs and three-dimensional computed tomography two weeks later, and (3) all three types of images two weeks after that. This cycle was then repeated to assess intraobserver reliability.

Results: Three-dimensional computed tomography improved the intraobserver agreement, but not the interobserver agreement, regarding the presence of coronal plane fracture lines and central articular fragment depression. Three-dimensional computed tomography improved both the intraobserver and the interobserver agreement regarding the presence of articular comminution. Interobserver agreement increased when three-dimensional computed tomography was used to determine the exact number of articular fracture fragments. The sensitivity and accuracy of identifying specific fracture characteristics (as compared with intraoperative findings) improved when three-dimensional imaging was used in conjunction with two-dimensional imaging as compared with two-dimensional imaging alone. The addition of three-dimensional computed tomography to two-dimensional computed tomography influenced treatment recommendations, resulting in a significantly greater number of decisions for an open approach (p < 0.05) and combined dorsal and volar exposure (p < 0.001).

Conclusions: Three-dimensional computed tomography improves both the reliability and the accuracy of radiographic characterization of articular fractures of the distal part of the radius and influences treatment decisions. Future studies will be required to determine the impact of these decisions on patient outcome.


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