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- Exploring third carpal bone fractures with CT and rads
Exploring third carpal bone fractures with CT and rads
VRU 2023 - 64(4): 661-668
Study: The study is a retrospective, methods comparison that aimed to explore the agreement between radiography and CT for imaging third carpal bone slab fractures and discuss the potential contribution of the latter to clinical case management.
Methods: The study included 82 Thoroughbred racehorses with a slab or incomplete slab fracture of the third carpal bone identified on radiographs that subsequently underwent CT examination. Fracture characteristics (location, plane, classification, displacement, comminution) and fracture length as a percentage of the proximodistal length of the bone were recorded independently from both modalities and then compared. Interobserver agreement and agreement between modalities were calculated using Fleiss Kappa and Cohen’s Kappa tests, respectively.
Results: The study found that there was substantial disagreement between radiographs and CT on the morphology of third carpal bone slab fractures. The modalities showed moderate agreement on fracture classification and displacement, slight agreement on the presence of comminution and there were few cases where there was disagreement on location and plane. Computed tomography predicted a higher frequency of complete, displaced, and comminuted fractures than radiographs. Computed tomography always provided evaluation of the proximodistal fracture length, but in 50% of cases radiographs could not. Where comparison was possible, CT yielded greater median proximodistal fracture percentage than radiographs that was statistically significant.
Limitations: The study had some limitations, such as the lack of a gold standard for comparison, the use of an axial CT acquisition technique that may be more susceptible to stair step artefact, and the possible selection bias of the study population.
Conclusions: The study concluded that radiography may underestimate the degree of comminution, displacement, and the fracture length of third carpal bone slab fractures. The study suggested that CT can assist in surgical planning and provide superior information than radiography for fractures of the third carpal bone.
Lateromedial radiograph (A) and multiplanar reconstructed computed tomographic image (B) of an incomplete fracture of the third carpal bone. Lines are present to illustrate the measurements used to calculate the proximodistal fracture percentage (PFP). Fracture length is measured from the proximal articular margin to the most distal identifiable extent of the fracture (purple line). The proximodistal depth of the bone is the distance between its proximal and distal articular margins at the same point, on the same image (blue line). PFP = purple length/blue length × 100. (Radiographs: CR, 68 kVp and 10 mAs, 1 m film to focal-spot distance. CT: Axial acquisition, 120 kV and 300 mAs, 512 × 512 matrix, 1.25 mm slice thickness, WW: 2800, WL: 800, bone kernel reconstruction).
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