Classification Of Distal Radius Fractures Research Articles

Diagnostics and classification of distal radius fractures

Fractures of the distal radius show awide spectrum of different fracture patterns. Although standard X‑ray images are sufficient for extra-articular fractures, the exact analysis of intra-articular fractures requires the use of computed tomography (CT) with coronal, sagittal and axial sectional images. The classification is based on the Working Group for Osteosynthesis Questions (AO) criteria. The treatment strategy can be more precisely defined by a CT-based classification. Special attention must be paid to the presence of the key corners, as they have a high risk for primary or secondary dislocation if they not adequately stabilized.

Cone-Beam Computed Tomography Influences the Classification and Choice of Treatment for Distal Radius Fractures

Abstract Background and Purposes The objectives of this study were to investigate the inter- and intraobserver agreement in the classification of distal radius fractures (DRFs) according to the AO and the Buttazzoni classification system, for the two different radiology modalities: conventional radiography (CR) and cone-beam computed tomography (CBCT). Furthermore, we aimed to explore whether the radiological modality used influences the choice of treatment. Patients and Methods Fifty consecutive patients with DRFs were included. The fractures were visualized by both CR and CBCT. All images were independently reviewed by five observers (three orthopaedic surgeons and two radiologists) and the fractures were classified according to the AO and the Buttazzoni classification. Agreement on fracture classification between CR and CBCT, interobserver agreement for all observers, and intraobserver agreement for a repeated assessment after 8 weeks were calculated. Treatment was suggested by the orthopaedic surgeons. Results The Buttazzoni classification showed higher interobserver agreement than the AO classification, but the agreement for the AO classification was increased using CBCT. The agreement between classification of fractures by CR and CBCT for each observer varied from fair to moderate. CBCT was superior for classification of dorsally comminute fractures using both the AO and the Buttazzoni system. In 38% (n = 57) of the observations, the suggested treatment was changed when CBCT was used, both from less advanced to more advanced and vice versa. Conclusion The choice of radiological modality affects both the classification and the choice of treatment for DRFs and CR tends to underestimate the complexity of DRFs. Level of Evidence Level 1.

AI-based detection and classification of distal radius fractures using low-effort data labeling: evaluation of applicability and effect of training set size

ObjectivesTo evaluate the performance of a deep convolutional neural network (DCNN) in detecting and classifying distal radius fractures, metal, and cast on radiographs using labels based on radiology reports. The secondary aim was to evaluate the effect of the training set size on the algorithm’s performance.MethodsA total of 15,775 frontal and lateral radiographs, corresponding radiology reports, and a ResNet18 DCNN were used. Fracture detection and classification models were developed per view and merged. Incrementally sized subsets served to evaluate effects of the training set size. Two musculoskeletal radiologists set the standard of reference on radiographs (test set A). A subset (B) was rated by three radiology residents. For a per-study-based comparison with the radiology residents, the results of the best models were merged. Statistics used were ROC and AUC, Youden’s J statistic (J), and Spearman’s correlation coefficient (ρ).ResultsThe models’ AUC/J on (A) for metal and cast were 0.99/0.98 and 1.0/1.0. The models’ and residents’ AUC/J on (B) were similar on fracture (0.98/0.91; 0.98/0.92) and multiple fragments (0.85/0.58; 0.91/0.70). Training set size and AUC correlated on metal (ρ = 0.740), cast (ρ = 0.722), fracture (frontal ρ = 0.947, lateral ρ = 0.946), multiple fragments (frontal ρ = 0.856), and fragment displacement (frontal ρ = 0.595).ConclusionsThe models trained on a DCNN with report-based labels to detect distal radius fractures on radiographs are suitable to aid as a secondary reading tool; models for fracture classification are not ready for clinical use. Bigger training sets lead to better models in all categories except joint affection.Key Points• Detection of metal and cast on radiographs is excellent using AI and labels extracted from radiology reports.• Automatic detection of distal radius fractures on radiographs is feasible and the performance approximates radiology residents.• Automatic classification of the type of distal radius fracture varies in accuracy and is inferior for joint involvement and fragment displacement.

Study on AO classification of distal radius fractures based on multi-feature fusion

Accurate classification of distal radius fracture is of great significance for improving the accuracy and success rate of subsequent bone-setting techniques. Based on the existing clinical distal radius fracture cases of the research group, this paper proposes an AO classification method based on distal radius fracture images based on multi-feature fusion for the problems of poor single feature expression and low accuracy of fracture classification by traditional classifiers and deep learning models. The fusion model uses two traditional features and the depth features extracted by AlexNet. After reducing the dimensions of the above features, a special neural network is designed to effectively fuse the reduced feature vectors. Finally, use the image retrieval classification scheme DML-K proposed in this paper to realize the specific classification of DRF images with the fused feature vectors. The experimental results show that the accuracy of the diagnostic model proposed in this paper on the distal radius fracture data set reaches 83.4%, and the F1 value reaches 0.815. Through horizontal and vertical comparison with other algorithms, the accuracy of the DRF diagnosis model proposed in this paper is increased by 5%, and the F1 value is increased by about 0.2, which fully verifies the effectiveness and feasibility of the method proposed in this study, and is expected to be applied Machine-aided diagnosis of distal radius fracture.

Research on Automatic Classification of Distal Radius Fractures Based on Deep Learning

Research on Automatic Classification of Distal Radius Fractures Based on Deep Learning

No association between osteoporosis and AO classification of distal radius fractures: an observational study of 289 patients

BackgroundIt is mechanically plausible that osteoporosis leads to more severe peripheral fractures, but studies investigating associations between BMD and radiographically verified complexity of distal radius fractures are scarce. This study aims to study the association between osteoporosis, as well as other risk factors for fracture, and the AO classification of distal radius fractures.MethodsIn this observational study, 289 consecutive patients aged ≥40 years with a distal radius fracture were included. Bone mineral density (BMD) of the hips and spine was measured by dual-energy x-ray absorptiometry (DXA), and comorbidities, medication, physical activity, smoking habits, body mass index (BMI), and history of previous fracture were registered. The distal radius fractures were classified according to the Müller AO system (AO) (type B and C regarded as most complex).ResultsPatients with osteoporosis (n = 130) did not have increased odds of a more complex distal radius fracture (type B + C, n = 192)) (n = vs type A (n = 92) (OR 1.1 [95% CI 0.5 to 2.3]) compared to those with osteopenia /normal BMD (n = 159). Patients with AO fracture types A or C had a higher prevalence of osteoporosis than patients with type B fracture.ConclusionsDistal radius fracture patients with osteoporosis did not sustain more complex fractures than those with osteopenia/normal BMD according to the AO classification system. The AO classification of distal radius fracture cannot be used to decide which patients should be referred to DXA scan and considered for secondary fracture prevention.

Classifications in Brief: Fernandez Classification of Distal Radius Fractures

AIM: Assess the scientific value and validity of the Fernandez classification to treat and study distal radius fractures. METHODS: A review article evaluated current and past literature to determine the interobserver reliability of the Fernandez classification and its application in distal radius fractures. A literature review was performed using search engines including Pubmed. RESULTS: The literature demonstrated kappa scores of initial distal radius fracture evaluation 0.39 and for a second look 3 months later to be 0.15. Intra-class correlations were 0.4 and 0.12 respectively demonstrating poor intra and interobserver reliability. Additionally, CT scans utilized after initial assessment via radiographs did not improve identification. CONCLUSION: This classification has only moderate reliability that was not improved by the addition of CT scans. When this classification was specifically tested in the clinical setting, it showed no reliability when predicting associated soft tissue or structure injury. The Fernandez classification system intention was to provide a treatment algorithm, it does not serve much use outside of its historical context in the understanding of distal radius fractures.

Classifications in Brief: Fernandez Classification of Distal Radius Fractures

Classifications in Brief: Fernandez Classification of Distal Radius Fractures

Impresión de modelos 3D para fracturas de radio distal: un estudio piloto en el Instituto Nacional de Rehabilitación

BACKGROUND: Although it has shown multiple benefits in preoperative fracture planning, 3D impressions have not been routinely implemented due to difficult access. MATERIAL AND METHODS: A pilot study was conducted with 10 patients with a diagnosis of distal radius fracture and need for surgical management. Patients were evaluated by radiography, tomography with 3D reconstruction and stereolithography prior to their surgical management. The editing of TAC images was done using the 3D SLICER® program for printing on thermoplastic material and finally a questionnaire of satisfaction was made to doctors and patients. RESULTS: 3D models of distal radius fractures were performed preoperatively. 100% of the patients clearly understood the severity of their condition. Doctors, reported a 42% improvement in fracture classification, 90% referred to 3D printing as a useful preoperative tool. CONCLUSIONS: 3D impressions promise to be a tool not only for a better understanding and classification of distal radius fractures, but also for a better understanding by our patients.

Delayed Fracture Healing in Diabetics with Distal Radius Fractures.

PURPOSE OF THE STUDY Diabetics may have an increased fracture risk, depending on disease duration, quality of metabolic adjustment and extent of comorbidities, and on an increased tendency to fall. The aim of this retrospective one-centre study consisted in detecting differences in fracture healing between patients with and without diabetes mellitus. Data of patients with the most common fracture among older patients were analyzed. MATERIAL AND METHODS Classification of distal radius fractures was established according to the AO classification. Inital assessment and followup were made by conventional x-rays with radiological default settings. To evaluate fracture healing, formation of callus and sclerotic border, assessment of the fracture gap, and evidence of consolidation signs were used. RESULTS The authors demonstrated that fracture morphology does not influence fracture healing regarding time span, neither concerning consolidation signs nor in fracture gap behavior. However, tendency for bone remodeling is around 70% lower in investigated diabetics than in non-diabetics, while probability for a successful fracture consolidation is 60% lower. CONCLUSIONS To corroborate the authors hypothesis of delayed fracture healing in patients with diabetes mellitus, prospective studies incorporating influencing factors like duration of metabolic disease, quality of diabetes control, medical diabetes treatment, comorbidities and secondary diseaseas, like chronic nephropathy and osteoporosis, have to be carried out. Key words: diabetes, delayed fracture healing, distal radius fractures, callus formation, blood glucose level, osteoblasts.

The use of plain radiographs in the classification of distal radius fractures

IntroductionClassification systems guide surgical planning. We reviewed the accuracy of interpreting plain radiographs to classify distal radius fractures. MethodsPre-operative radiographs of 24 consecutive distal radius fractures were classified using Frykman and AO methods. Classification was repeated intra-operatively under direct vision for comparison. ResultsMean age of the patients was 51 years. Pre-operative Frykman scores and AO grades were underestimated, compared with intra-operative visual classification (p < 0.001). One over-estimate occurred, while only 3 of 24 cases were classified correctly pre-operatively. ConclusionSensitivity of radiographs to classify Frykman or AO grades was 12.5%, indicating interpretation using plain radiographs alone is often inadequate.

Classification of distal radius fractures in children: good inter- and intraobserver reliability, which improves with clinical experience

BackgroundWe wanted to test the reliability of a commonly used classification of distal radius fractures in children.Methods105 consecutive fractures of the distal radius in children were rated on two occasions three months apart by 3 groups of doctors; 4 junior registrars, 4 senior registrars and 4 orthopedic consultants. The fractures were classified as buckle, greenstick, complete or physeal. Kappa statistics were used to analyze inter- and intraobserver reliability.ResultsThe kappa value for interobserver agreement at the first reading was 0.59 for the junior registrars, 0.63 for the senior registrars and 0.66 for the consultants. The mean kappa value for intraobserver reliability was 0.79 for the senior registrars, 0.74 for the consultants and 0.66 for the junior registrars.ConclusionsWe conclude that the classification tested in this study is reliable and reproducible when applied by raters experienced in fracture management. The reliability varies according to the experience of the raters. Experienced raters can verify the classification, and avoid unnecessary follow-up appointments.

Classificando fraturas do rádio com raio-X e tomografia

INTRODUÇÃO: Este estudo avaliou a confiabilidade interobservador da radiografia simples versus tomografia computadorizada para as classificações Universal e AO em fraturas do rádio distal. PACIENTES e MÉTODOS: Cinco observadores classificaram 21 fraturas do rádio distal utilizando radiografias e tomografias independentemente. O índice Kappa foi utilizado para estabelecer o nível de concordância entre os observadores. RESULTADOS: A confiabilidade interobservador da classificação Universal foi moderada e a confiabilidade interobservador da classificação AO foi baixa. Reduzindo a clas-sificação AO a nove categorias e às três categorias básicas houve melhora do nível de confiabilidade para "moderado". Não houve diferença entre a confiabilidade interobservador da classificação Universal baseada em imagens radiográficas em comparação com a classificação Universal baseada em imagens tomográficas. A confiabilidade interobservador da classificação AO baseada em radiografias simples foi significativamente maior que a confiabilidade interobservador da classificação AO baseada apenas em tomografias computadorizadas. CONCLUSÃO: A partir destes dados, concluímos que classificar fraturas do rádio distal utilizando tomografias computadorizadas sem o auxílio das radiografias simples não traz benefício.

Do We Need to Include Osteoporosis in Today's Classification of Distal Radius Fractures?

Although the correlation between decreased bone mineral density and increased incidence of distal radius fractures is widely acknowledged, the effect of osteoporosis on specific fracture types is seldom addressed. No classification system has been established for clinical use that has been validated for osteoporotic fractures or that includes parameters of the bone density or bone quality. So far, only one experimental study could report a clear correlation between bone properties and fracture patterns, and an additional clinical study assesses bone density in relation to displacement in Colles fractures. Further studies are needed to analyze the intra- and interobserver reproducibility of more simplified but nonetheless comprehensive classification systems that recognize the impact of osteoporosis on distal radius fracture and that specifically incorporate bone mineral density.

Diagnosis and treatment of comminuted distal radius fractures with inverted articular surface

Objeciive To discuss the diagnosis and treatment of comminuted distal radius fractures with inverted atticular surface. Methods Five sides of 4 patients with comminuted distal radius fractures with inverted articular surface were diagnosed by using computerized tomography scanning and 3-dimensional reconstruction technique.The fractures were treated with orthofix external fixator combined with limited intemal fixation. Resuits Correet diagnosis was made in 3 cases preoperatively based on CT scans and 3D reconstruction.Missed diagnosis occurred in 1 case(2 sides).It was diagnosed through reviewing CT scans and 3D reconstruction after the operation.Reduction was achieved and maintained in 3 cases.All the patients were followed-up for 6 to 30 months(12 months on average).According to the anatomical allgnment,3 were excellent,1 good,and 1 fair.Preoperatively,the radial inclination angle was-10°to 15°(12.5°on average)The palmar tilt angle was-25°to 0°(-10°on average).After the operation,the two angels were restored to 20°to 30°(25°on average),and 0°to 20°(11.0°on average)respectively.The joint function Was assessed bv Dienst criteria.the results suggested that 4 were graded as exceHent and 1 as good.No complications such as pin tract infection,pin tract fracture.neurovasculat-injuries,wound infection and osteomyelitis were found. Conclusion Computerized tomography scanning and 3-dimensional reconstruction technique is reliable and necessary for the diagnosis and classification of comminuted distal radius fractures with inverted articular surface.External fixator combined with limited internal fixation is an effective treatment in that it i8 easy to perform.provides reliable fixation.and causes litile complications. Key words: Fractures,comminuted; External fixators; Diagnosis; Distal radius fracture

The interobserver and intraobserver reliability of the cooney classification of distal radius fractures between experienced orthopaedic surgeons

Various classification systems have been proposed for fractures of the distal radius, but the reliability of these classifications are seldom addressed. The objective of this study was to determine the interobserver and intraobserver reliability of the Cooney classification. Five orthopaedic surgeons with more than 10 years' experience in orthopaedic trauma assessed 43 sets of radiographic files according to the Cooney classification separately. Kappa statistics were used to analyse the interobserver and intraobserver reliability. There was moderate and substantial interobserver and intraobserver reliability of the Cooney classification without subtype, but only slight reliability when the subgroups were considered. These results question the value of this classification system for treatment decision making.

Classification of distal radius fractures: An analysis of interobserver reliability and intraobserver reproducibility

The Frykman, Melone, Mayo, and AO classification systems for distal radius fractures were evaluated for interobserver reliability and intraobserver reproducibility in a clinical setting using initial plain radiographs. Two attending orthopedic hand surgeons and two attending radiologists classified 55 sets of distal radius fractures. kappa-statistics were used to establish a relative level of agreement between observers for the two readings and between separate readings by the same observer. Interobserver agreement was rated as moderate for the Mayo classification and fair for the Frykman, Melone, and AO classifications. Intraobserver agreement was substantial for only one of four observers for each of the Frykman, Melone, and Mayo, while the remaining three observers achieved only fair to moderate reproducibility. Intraobserver agreement for the AO classification was fair for all four of the observers. Neither interobserver or intraobserver agreement was affected by combining similar subclasses in the Melone classification or by reducing the number of categories in the AO system from 27 to 9. However, further reducing the AO system to its three main types brought agreement to the "substantial" level. No difference was found in interobserver agreement between the first and second readings or in interobserver or intraobserver agreement between orthopedic hand surgeons and radiologists. Understanding the limitations of fracture classifications based solely on plain radiographs can help avoid undue reliance on them. Given the low degree of interobserver and intraobserver agreement for each of the distal radius fracture classifications in this study, their use as the sole means for determining the direction of treatment or for the direct comparison of results among different studies is not warranted.