Comparison of visual estimations of distal radius fracture radiographic parameters between different levels of orthopaedic doctors

Abstract

Background: Distal radius fractures are common injuries in South Africa. Accurate and decisive radiographic parameter interpretation is key in appropriate management. Digital radiographic facilities are rare in the public setting and goniometer usage is low; thus, visual estimates are the primary form of radiographic assessment. Previous research has associated orthopaedic experience with accuracy of distal radius fracture parameter estimation, but often, doctors treating orthopaedic patients are not experienced in orthopaedics. Differences in radiographic visual estimation accuracy between different experience levels of orthopaedic doctors has yet to be explored in this setting.

Methods: A cross-sectional questionnaire including four distal radius fracture radiographs was administered to 149 orthopaedic doctors at three teaching hospitals. Participants were grouped into ranks of consultants (n = 36), registrars (n = 41), medical officers (n = 20) and interns (n = 52). Participants estimated values of distal radius fracture parameters visually, stated whether they would accept the position of the fractures, and stated their percentage of routine usage of goniometers in real practice.

Results: The registrar group was most accurate in visually estimating radial height (p = 0.024), while the consultant, registrar and medical officer groups were equally accurate in estimating radial inclination. The consultant and registrar groups were equally accurate at estimating volar tilt, while the medical officer and intern groups were least accurate (p < 0.001). The intern group was also the least accurate in estimating radial height and radial inclination (p < 0.001). The Gwet’s AC1 agreement was 0.161 (p = 0.047) for acceptance of the position of the first radiograph, 0.877 (p < 0.001) for the second, 0.888 (p < 0.001) for the third, and 0.806 (p < 0.001) for the fourth. All groups showed no difference in goniometer usage, using them largely in 0–25% of practice (p = 0.194).

Conclusion: Accuracy of visual estimations of distal radius fracture parameters was associated with orthopaedic experience but not with inter-rater agreement on acceptability of fracture position, nor with routine goniometer usage level. Visual estimates do not match the accuracy of goldstandard goniometer or digital measurements, regardless of orthopaedic experience level.

Level of evidence: 3