Automatically Computed Distal Radius Fractures Radiographic Measurements Improve Clinical Decision Consistency of Expert Orthopaedic Surgeons
2Orthopaedics, Hadassah Medical Center, Israel
3School of Computer Science and Engineering, The Hebrew University of Jerusalem, Computer-Assisted Surgery and Medical Image Processing Laboratory, Israel
Background:
This research was conducted in collaboration between Hadassah Medical Centre and the CASMIP Lab, School of Computer Science and Engineering, The Hebrew University of Jerusalem. A semi-automatic computer program was developed to compute specific radiographic measurements. In the anteroposterior radiograph, articular step and gap, radial inclination, radial length, radial shift and ulnar variance were computed. In the lateral radiographs articular gap and step, palmar tilt and dorsal shift were computed. The goal of this study is to establish the effect of the measurements on the surgery decision.
Method:
Thirty-one radiographic images of patients with distal radius fractures were collected from the Hadassah hospital data base and were presented to 9 orthopaedic trauma or hand specialists which routinely treat these injuries. The radiographs were provided with a short description stating the age, hand dominance, major comorbidities and the routine physical activity status of the patient. The clinicians had to decide if they recommend surgical or non-surgical treatment. After a period of 3 weeks the radiographs were provided again with the addition of the automatically radiographic measurements. The clinicians were asked again to decide if they recommend a surgical or non-surgical treatment. In both surveys, 4 cases were duplicated to establish the interobserver variability. Clinicians were from two different hospitals and consist of 5 hand specialist and 4 trauma specialists. Inter and intra observer consistency between the two surveys was calculated to investigate if the radiographic parameters that were provided in the second survey improved the treatment decision consistency between the clinicians.
Results:
Inter observer consistency was 77% in the first survey (without the radiographic measurements) and 86% in the second survey (with the radiographic measurements) with a P-value of 0.013. The interobserver consistency of the clinicians between the surveys was 0.75, meaning that in one out of four cases clinicians differed in their decision. That in contrast to similar interobserver variability of 0.9 in the duplicated cases in both surveys.
Conclusion:
In this study we show that providing automatically radiographic measurements to highly specialized orthopaedic surgeons improved the consistency of their clinical decisions in distal radius fractures. Further research with larger number of clinicians is indicated to analyse the effect on specific subgroups of surgeons like seniority and different sub-specialty.