Intraobserver and interobserver variability in diagnosing scapholunate dissociation by cineradiography

Abstract

Purpose: To evaluate the intraobserver and interobserver variability in diagnosing scapholunate dissociation (SLD) by wrist cineradiography.

Methods: A musculoskeletal radiologist, hand surgeon, and trauma surgeon assessed the records of 50 consecutive wrist cineradiographies performed in 25 patients. Fluoroscopy was performed on the unaffected and affected wrist and consisted of radiographer-controlled passive flexion-extension and passive radial-ulnar deviation in both posteroanterior and lateral projections. To determine the intraobserver variability, the 3 reviewers reassessed all wrist cineradiographies 6 months after their first assessment. The kappa coefficient for interobserver agreement was calculated using the jackknife method. The Cohen kappa was used to assess intraobserver variability.

Results: The interobserver variability for diagnosing SLD by cineradiography was excellent (κ = 0.84). The intraobserver variability for the hand surgeon was excellent (κ = 0.80), and was good for the radiologist (κ = 0.72) and the trauma surgeon (κ = 0.76).

Conclusions: Cineradiography is a promising and helpful, noninvasive tool for diagnosing SLD. It is widely available and has relatively low costs. Conventional radiographs remain essential in the primary workup for suspected SLD. However, we recommend cineradiography when an SLD is clinically suspected.

Type of study/level of evidence: Diagnostic III.

Keywords: Interobserver variability; intraobserver variability; scapholunate dissociation; scapholunate ligament; wrist cineradiography.