Abstract
Purpose
This study aimed to compare the consistency among surgeons of varying experience levels in classifying distal radius articular collapse fractures using conventional CT scans and 3D images reconstructed with software MIMICS 26.0 (MIMICS, Boston, MA)according to the AO classification. Additionally, the study compared the consistency in identifying the position of isolated bone fragments on the articular surface using both imaging methods. The aim was to determine a more practical approach for the AO classification of distal radius articular collapse fractures and identifying isolated bone fragment positions, thereby assisting clinicians in preoperative decision-making.
Methods
The study included 80 patients with distal radius articular collapse fractures. Four independent assessors (two senior and two junior orthopedic clinicians) evaluated the fractures' AO classification and the relative positions of isolated articular bone fragments using conventional CT images and 3D reconstructed images. After six weeks, the 80 cases were randomly reassigned, and all assessors re-evaluated the abovementioned parameters. The intraclass correlation coefficient (ICC) was used to calculate inter-observer and intra-observer reliability, presented with a 95% confidence interval.
Results
The results showed that AO classification of distal radius articular collapse fractures using 3D reconstructed images had lower overall inter-observer consistency (0.577 (0.369–0.729)) compared to direct AO classification from conventional CT scans (0.642 (0.486–0.761)). However, determining the relative positions of bone fragments in the coronal plane using 3D reconstructed images showed higher overall inter-observer consistency (coronal plane 0.806 (0.700–0.882); sagittal plane 0.809 (0.712–0.879)) compared to conventional CT scans (coronal plane 0.762 (0.635–0.852); sagittal plane 0.698 (0.558–0.802)).
Conclusion
In conclusion, for distal radius articular collapse fractures, the consistency in AO classification assessments among observers was generally moderate, influenced by the experience level of the doctors. Junior doctors showed higher consistency in classification assessments using 3D reconstruction, while senior doctors had higher consistency using conventional CT scans. The method of observation for bone fragment positions, whether by conventional CT scan or 3D reconstruction of the distal radius, showed differences in consistency, with 3D reconstruction reaching almost perfect consistency levels in identifying bone fragment positions on the articular surface.