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. 2019 Nov;14(6):797-802.
doi: 10.1177/1558944718777831. Epub 2018 Jun 5.

Accuracy and Reliability of Radiographic Estimation of Volar Lip Fragment Size in PIP Dorsal Fracture-Dislocations

Daniel S Donovan  1 , Jeremy D Podolnick  1 , Wayne Reizner  2 , O Alton Barron  3 , Louis W Catalano 3rd  3 , Steven Z Glickel  3
Affiliations

Accuracy and Reliability of Radiographic Estimation of Volar Lip Fragment Size in PIP Dorsal Fracture-Dislocations

Daniel S Donovan et al. Hand (N Y). 2019 Nov.

Abstract

Background: A cadaveric study was performed to evaluate the accuracy and reliability of radiographic estimation of the volar lip fragment size in proximal interphalangeal joint fracture-dislocations. Methods: Middle phalangeal base volar lip fractures of varying size and morphology were simulated in 18 digits. Radiographs and digital photographs of the middle phalangeal joint surface were obtained pre- and postinjury. Ten orthopedic surgeons of varying levels of training estimated the fracture size based on radiographs. The estimated joint involvement on radiograph was compared with the digitally measured joint involvement. Results: Radiographic estimation underestimated the volar lip fragment size by 9.02%. Estimations possessed high intraobserver (0.76-0.98) and interobserver (0.88-0.97) reliabilities. No differences were detected between levels of surgeon training. Conclusions: The significant underestimation of the volar lip fragment size demonstrates the lack of radiographic estimation accuracy and suggests that surgeons should be mindful of these results when making treatment plans.

Keywords: diagnostic; fracture-dislocation; proximal interphalangeal joint; radiograph; volar lip.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
(a) The shotgunned joint with fracture joint surface reduced. The volar fragment is adjacent to the ruler. (b) The known value from the ruler at the joint surface is used to calibrate the software. (c and d) Measuring total area of the joint and the dorsal area (two of the measurements used to determine the total area fractured).
Figure 2.
Figure 2.
Posteroanterior and lateral radiographs of a fractured digit blinded for review.
Figure 3.
Figure 3.
Posteroanterior and lateral radiographs of a fractured digit including prefracture image for comparison—both blinded for review.
Figure 4.
Figure 4.
Average percentage of volar fragment size with error bars as 95% confidence intervals. Measurements made from radiographs to the left in blue, and digitally measured in red on the right.
Figure 5.
Figure 5.
The intraclass correlation coefficient for the agreement among each single rater’s 4 readings.
See this image and copyright information in PMC

References

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