Scaphoid Length Loss Following Nonunion Is Associated with Dorsal Intercalated Segment Instability.

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Abstract

Conflict of interest statement: Conflict of Interest None declared. 19. Bone Joint J. 2020 Apr;102-B(4):478-484. doi: 10.1302/0301-620X.102B4.BJJ-2019-0632.R3. The interobserver reliability of the diagnosis and classification of scaphoid fractures using high-resolution peripheral quantitative CT. Daniels AM(1)(2), Wyers CE(2)(3)(4), Janzing HMJ(1), Sassen S(5), Loeffen D(6), Kaarsemaker S(7), van Rietbergen B(8)(9), Hannemann PFW(10), Poeze M(2)(10), van den Bergh JP(2)(3)(4). Author information: (1)Department of Surgery, ViCuri Medical Centre, Venlo, The Netherlands. (2)NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands. (3)Department of Internal Medicine, Subdivision of Endocrinology, ViCuri Medical Centre, Venlo, The Netherlands. (4)Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands. (5)Department of Radiology, ViCuri Medical Centre, Venlo, The Netherlands. (6)Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands. (7)Department of Orthopaedic Surgery, ViCuri Medical Centre, Venlo, The Netherlands. (8)Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands. (9)Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Centre, Maastricht, The Netherlands. (10)Department of Surgery and Trauma Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands. AIMS: Besides conventional radiographs, the use of MRI, CT, and bone scintigraphy is frequent in the diagnosis of a fracture of the scaphoid. However, which techniques give the best results remain unknown. The investigation of a new imaging technique initially requires an analysis of its precision. The primary aim of this study was to investigate the interobserver agreement of high-resolution peripheral quantitative CT (HR-pQCT) in the diagnosis of a scaphoid fracture. A secondary aim was to investigate the interobserver agreement for the presence of other fractures and for the classification of scaphoid fracture. METHODS: Two radiologists and two orthopaedic trauma surgeons evaluated HR-pQCT scans of 31 patients with a clinically-suspected scaphoid fracture. The observers were asked to determine the presence of a scaphoid or other fracture and to classify the scaphoid fracture based on the Herbert classification system. Fleiss kappa statistics were used to calculate the interobserver agreement for the diagnosis of a fracture. Intraclass correlation coefficients (ICCs) were used to assess the agreement for the classification of scaphoid fracture. RESULTS: A total of nine (29%) scaphoid fractures and 12 (39%) other fractures were diagnosed in 20 patients (65%) using HR-pQCT across the four observers. The interobserver agreement was 91% for the identification of a scaphoid fracture (95% confidence interval (CI) 0.76 to 1.00) and 80% for other fractures (95% CI 0.72 to 0.87). The mean ICC for the classification of a scaphoid fracture in the seven patients diagnosed with scaphoid fracture by all four observers was 73% (95% CI 0.42 to 0.94). CONCLUSION: We conclude that the diagnosis of scaphoid and other fractures is reliable when using HR-pQCT in patients with a clinically-suspected fracture. Cite this article: Bone Joint J 2020;102-B(4):478-484. DOI: 10.1302/0301-620X.102B4.BJJ-2019-0632.R3