Postoperative imaging of orthopaedic hardware in the hand and wrist: is there an added value for tomosynthesis?

Aim To prospectively investigate digital tomosynthesis (DTS) as an alternative to digital radiography (DR) for postoperative imaging of orthopaedic hardware after trauma or arthrodesis in the hand and wrist. Materials and methods Thirty-six consecutive patients (12 female, median age 36 years, range 19–86 years) were included in this institutional review board approved clinical trial. Imaging was performed with DTS in dorso-palmar projection and DR was performed in dorso-palmar, lateral, and oblique views. Images were evaluated by two independent radiologists for qualitative and diagnosis-related imaging parameters using a four-point Likert scale (1=excellent, 4 not diagnostic) and nominal scale. Interobserver agreement between the two readers was assessed with Cohen's kappa (k). Differences between DTS and CR were tested with Wilcoxon's signed-rank test. A p-value Results Regarding image quality, interobserver agreement was higher for DTS compared to DR, especially for fracture-related parameters (delineation osteosynthesis material [OSM]: KDTS 0.96 versus KDR 0.45; delineation fracture margins: KDTS 0.78 versus KDR 0.35). Delineation of fracture margins and delineation of adjacent joint spaces scored significant better for DTS compared to DR (delineation fracture margins: DTS 1.54, DR 2.28, p 0.001; delineation adjacent joint spaces: DTS 1.31, DR 2.24, p 0.001). Regarding diagnosis-related findings, interobserver agreement was almost equal. DTS showed a significant higher sharpness of fracture margins (DTS 1.94, DR 2.33, p 0.04). Mean dose area product (DAP) for DTS was significant higher compared to DR (mean DR 0.219 Gy·cm2, mean DTS 0.903 Gy·cm2, p 0.001). Conclusion Fracture healing is more visible and interobserver agreement is higher for DTS compared to DR in the postoperative assessment of orthopaedic hardware in the hand and wrist.