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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

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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.

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.

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.

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.

No MeSH data available.


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The CT scan in pronation of a 24-year-old female, 4 years and 4 months after a complete intraarticular fracture on the left side. Using the epicenter method, this wrist was measured out of the normal range, compared to normal values based on mean measurements. She indicated no (0) pain using the VAS score
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Fig5: The CT scan in pronation of a 24-year-old female, 4 years and 4 months after a complete intraarticular fracture on the left side. Using the epicenter method, this wrist was measured out of the normal range, compared to normal values based on mean measurements. She indicated no (0) pain using the VAS score

Mentions: This study had a number of limitations. Although the protocol stated that the largest area of the sigmoid notch should be selected, including Lister’s tubercle on the axial reformatted CT images, it seems probable that different slides were selected for conducting the measurements (Fig. 5). A computerized system may overcome this shortcoming. Another limitation of this study was that only the reliability of determination of clinical DRUJ instability on CT scans could be evaluated. Since no reliable and objective test is available for diagnosing DRUJ instability, we were not able to evaluate the validity of CT scans for determination of clinical DRUJ instability. Nevertheless, these results are valuable given the lack of reliable data on the evaluation of methods for diagnosing radiological DRUJ instability using CT in injured wrists.Fig. 5


Computed tomography for the detection of distal radioulnar joint instability: normal variation and reliability of four CT scoring systems in 46 patients
The CT scan in pronation of a 24-year-old female, 4 years and 4 months after a complete intraarticular fracture on the left side. Using the epicenter method, this wrist was measured out of the normal range, compared to normal values based on mean measurements. She indicated no (0) pain using the VAS score
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC5037146&req=5

Fig5: The CT scan in pronation of a 24-year-old female, 4 years and 4 months after a complete intraarticular fracture on the left side. Using the epicenter method, this wrist was measured out of the normal range, compared to normal values based on mean measurements. She indicated no (0) pain using the VAS score
Mentions: This study had a number of limitations. Although the protocol stated that the largest area of the sigmoid notch should be selected, including Lister’s tubercle on the axial reformatted CT images, it seems probable that different slides were selected for conducting the measurements (Fig. 5). A computerized system may overcome this shortcoming. Another limitation of this study was that only the reliability of determination of clinical DRUJ instability on CT scans could be evaluated. Since no reliable and objective test is available for diagnosing DRUJ instability, we were not able to evaluate the validity of CT scans for determination of clinical DRUJ instability. Nevertheless, these results are valuable given the lack of reliable data on the evaluation of methods for diagnosing radiological DRUJ instability using CT in injured wrists.Fig. 5

View Article: PubMed Central - PubMed

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.

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.

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.

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.

No MeSH data available.


Related in: MedlinePlus