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Computed tomography for the detection of distal radioulnar joint instability: normal variation and reliability of four CT scoring systems in 46 patients.
- Source :
-
Skeletal radiology [Skeletal Radiol] 2016 Nov; Vol. 45 (11), pp. 1487-93. Date of Electronic Publication: 2016 Aug 24. - Publication Year :
- 2016
-
Abstract
- Objectives: The diagnosis of distal radioulnar joint (DRUJ) instability is clinically challenging. Computed tomography (CT) may aid in the diagnosis, but the reliability and normal variation for DRUJ translation on CT have not been established in detail. The aim of this study was to evaluate inter- and intraobserver agreement and normal ranges of CT scoring methods for determination of DRUJ translation in both posttraumatic and uninjured wrists.<br />Materials and Methods: Patients with a conservatively treated, unilateral distal radius fracture were included. CT scans of both wrists were evaluated independently, by two readers using the radioulnar line method, subluxation ratio method, epicenter method and radioulnar ratio method. The inter- and intraobserver agreement was assessed and normal values were determined based on the uninjured wrists.<br />Results: Ninety-two wrist CTs (mean age: 56.5 years, SD: 17.0, mean follow-up 4.2 years, SD: 0.5) were evaluated. Interobserver agreement was best for the epicenter method [ICC = 0.73, 95 % confidence interval (CI) 0.65-0.79]. Intraobserver agreement was almost perfect for the radioulnar line method (ICC = 0.82, 95 % CI 0.77-0.87). Each method showed a wide normal range for normal DRUJ translation. Normal range for the epicenter method is -0.35 to -0.06 in pronation and -0.11 to 0.19 in supination.<br />Conclusion: DRUJ translation on CT in pro- and supination can be reliably evaluated in both normal and posttraumatic wrists, however with large normal variation. The epicenter method seems the most reliable. Scanning of both wrists might be helpful to prevent the radiological overdiagnosis of instability.<br />Competing Interests: The authors declare that they have no conflict of interest. Ethical approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
- Subjects :
- Adolescent
Adult
Aged
Aged, 80 and over
Anatomic Landmarks diagnostic imaging
Arthrography methods
Female
Humans
Male
Middle Aged
Observer Variation
Radiographic Image Interpretation, Computer-Assisted methods
Reference Values
Reproducibility of Results
Sensitivity and Specificity
Young Adult
Joint Instability diagnostic imaging
Radius diagnostic imaging
Radius Fractures diagnostic imaging
Tomography, X-Ray Computed methods
Ulna diagnostic imaging
Wrist Injuries diagnostic imaging
Wrist Joint diagnostic imaging
Subjects
Details
- Language :
- English
- ISSN :
- 1432-2161
- Volume :
- 45
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- Skeletal radiology
- Publication Type :
- Academic Journal
- Accession number :
- 27554667
- Full Text :
- https://doi.org/10.1007/s00256-016-2455-y