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Kleinlugtenbelt YV, Madden K, Groen SR, et al. Can experienced surgeons predict the additional value of a CT scan in patients with displaced intra-articular distal radius fractures?. Strategies Trauma Limb Reconstr. 2017;12(2):91-97doi: 10.1007/s11751-017-0283-9.
Kleinlugtenbelt, Y. V., Madden, K., Groen, S. R., Ham, S. J., Kloen, P., Haverlag, R., Simons, M. P., Bhandari, M., Goslings, J. C., Scholtes, V. A. B., & Poolman, R. W. (2017). Can experienced surgeons predict the additional value of a CT scan in patients with displaced intra-articular distal radius fractures?. Strategies in trauma and limb reconstruction, 12(2), 91-97. https://doi.org/10.1007/s11751-017-0283-9
Kleinlugtenbelt, Y V, et al. "Can experienced surgeons predict the additional value of a CT scan in patients with displaced intra-articular distal radius fractures?." Strategies in trauma and limb reconstruction vol. 12,2 (2017): 91-97. doi: https://doi.org/10.1007/s11751-017-0283-9
Kleinlugtenbelt YV, Madden K, Groen SR, Ham SJ, Kloen P, Haverlag R, Simons MP, Bhandari M, Goslings JC, Scholtes VAB, Poolman RW. Can experienced surgeons predict the additional value of a CT scan in patients with displaced intra-articular distal radius fractures?. Strategies Trauma Limb Reconstr. 2017 Aug;12(2):91-97. doi: 10.1007/s11751-017-0283-9. Epub 2017 Apr 24. PMID: 28439818; PMCID: PMC5505880.
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Strategies Trauma Limb Reconstr. 2017 Aug;12(2):91-97. doi: 10.1007/s11751-017-0283-9. Epub 2017 Apr 24.

Can experienced surgeons predict the additional value of a CT scan in patients with displaced intra-articular distal radius fractures?.

Strategies in trauma and limb reconstruction

Y V Kleinlugtenbelt, K Madden, S R Groen, S J Ham, P Kloen, R Haverlag, M P Simons, M Bhandari, J C Goslings, V A B Scholtes, R W Poolman

Affiliations

  1. Department of Orthopaedic and Trauma Surgery, Joint Research OLVG, Oosterpark 9, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands. [email protected].
  2. Department of Orthopaedic and Trauma Surgery, Deventer Ziekenhuis, Nico Bolkesteinlaan 75, 7416 SE, Deventer, The Netherlands. [email protected].
  3. Division of Orthopaedic Surgery, McMaster University, 293 Wellington St N Suite 110, Hamilton, ON, L8L 8E7, Canada. [email protected].
  4. Division of Orthopaedic Surgery, McMaster University, 293 Wellington St N Suite 110, Hamilton, ON, L8L 8E7, Canada.
  5. Department of Orthopaedic and Trauma Surgery, Joint Research OLVG, Oosterpark 9, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands.
  6. Department of Orthopaedic and Trauma Surgery, Academic Medical Centre, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
  7. Department of General and Trauma Surgery, OLVG, Oosterpark 9, P.O. Box 95500, 1090 HM, Amsterdam, The Netherlands.
  8. Trauma Unit, Department of Surgery, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.

PMID: 28439818 PMCID: PMC5505880 DOI: 10.1007/s11751-017-0283-9

Abstract

There are no clear guidelines when an additional CT scan should be obtained for the treatment of displaced intra-articular distal radius fractures (DRF). This study aimed to investigate whether surgeons can predict the usefulness of CT scans to facilitate choice of treatment plan and/or pre-operative planning for DRF. Four surgeons evaluated 51 patients with displaced DRF. The choice of treatment (operative or nonoperative) was based on conventional radiographs. Subsequently, the surgeons were asked whether they would have requested an additional CT scan to determine this treatment choice, and also whether they required a CT scan for pre-operative planning. After 4 weeks, the additional CT scan was provided and the cases were assessed again. Based on these data, we calculated the number needed to scan (NNS) and number needed to harm (NNH) for two decision models. Model 1: Only provide a CT scan if the surgeon requested one based on their judgment of the X-rays. Model 2: CT scans for all displaced intra-articular DRF. For choice of treatment, the NNS was lower for model 1 than for model 2 (2.6 vs. 4.3) and the NNH is higher for model 1 (3.1 vs. 1.3). For pre-operative planning, the NNS (1.3 vs. 1.4) and NNH (3.7 vs. 3.4) were comparable for both models. Surgeons are able to predict the usefulness of an additional CT scan for intra-articular displaced DRF for OR indication. However, for pre-operative planning the usefulness of a CT scan is much harder to predict.

Keywords: CT scans; Clinical decision making; Distal radius fractures

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