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 known to be 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, oftentimes, doctors treating orthopaedic patients are not experienced in orthopaedics. Methods A cross-sectional questionnaire including four distal radius fracture radiographs was administered to 149 orthopaedic doctors at three Johannesburg teaching hospitals. Participants were grouped into ranks of: consultants (n = 36), registrars (n = 41), medical officers (n = 20) and interns (n = 52). Participants visually estimated values of distal radius fracture parameters, 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 = 0.0237), while the consultant, registrar and medical officer groups were equally as accurate in estimating radial inclination. The consultant and registrar group were equally accurate at estimating volar tilt, whilst the medical officer and intern groups were least accurate (p < 0.0001). The intern group were also the least accurate in estimating radial height and radial inclination (p < 0.0001). The Gwet’s AC agreement was 0.1612 (p = 0.047) for acceptance of position of the first radiograph, 0.8768 (p < 0.0001) for the second, 0.8884 (p < 0.0001) for the third and 0.8064 5 (p < 0.0001) for the fourth. All groups showed no difference in goniometer usage, using them largely 0-25% of practice (p = 0.1937). Conclusion In the study, it was found that accuracy in visual estimations of distal radius fracture parameters was linked to orthopaedic experience but not linked to routine practice goniometer usage, which was minimal across all groups. Inter-rater agreement on acceptability of fracture position is potentially dependent on severity of deviation from acceptable parameters.