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Distal Radius Traction Views: Inter- and Intra-observer Reliability with Comparison to Computed Tomography
Daniel M. Avery, MD; Kristofer S. Matullo, MD
St. Luke's University Hospital and Health Network, Bethlehem, PA

Introduction: Our goal was to compare five traction view images to CT images to evaluate the interobserver and intraobserver reliability of individual fracture fragment identification, the correct identification of fracture fragments on CT imaging versus traction views, and consistency of treatment recommendations.
Materials and Methods: Eleven observers were asked to evaluate two blinded presentations of either traction images or CT images displaying seventeen different intra-articular distal radius fractures. Each observer was then asked to identify the presence or absence of six specific fracture fragments (radial column, dorsal wall, dorsal ulnar corner, volar ulnar corner, volar rim, and central impaction) and recommend treatment (nonoperative, open reduction internal fixation, external fixation/distraction plating). Analysis were then conducted to evaluate the interobserver reliability of traction view images and CT images for fracture fragment identification, intraobserver variability for fragment identification, correct fracture fragment identification with traction views versus a CT gold standard, and assess the consistency in treatment selection.
Results: Interobserver reliability for traction view images and CT images were both fair to poor. Intraobserver variability for fragment identification was similar for each fragment without statistical significance. Correct identification of fracture fragments was significantly better with the radial column on CT imaging (71.8%) and the volar rim fragment with traction view imaging (72.7%). Treatment recommendation was similar for each imaging modality agreeing in 80.9% of situations for ORIF and 67.9% for external fixation.
Conclusion: Traction view images are a suitable alternative to CT imaging for distal radius fractures. Our data shows similar interobserver reliability as compared to CT imaging, no significant difference with regard to intraobserver variability, consistent correct identification in 4 of 6 major fracture fragments, and little difference with regard treatment recommendations.


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