Avaliação da concordância interobservadores da tomografia computadorizada e seu papel em modificar a classificação e o tratamento das fraturas da extremidade distal do rádio quando comparada à radiografia convencional

Abstract

Fractures of the distal end of the radius are very common and can lead to future degenerative changes if not treated properly. The CT scan is considered to show more precisely the steps and rotational deviations of these fractures, but are not routinely used for initial patient assessment. The objective of the present study was to determine whether CT scan is useful for planning and treating the fractures of the distal radius in adults showing the level of interobserver agreement for classifying and treating fractures and if CT scan changes the directions of the treatment previously indicated only with conventional radiography. Five observers with similar professional backgrounds in Hand Surgery evaluated the CT scans and radiographs of 36 patients with fractures of the distal radius that were distributed by a moderator in a blind form, by chance. A total of 180 CT scans and 180 X-rays were evaluated. Fractures were classified using the Universal and AO methods by the observers who indicated, as well, one of the five treatments previously pre-determined, evaluating randomly the x-rays and CT scans on both situations. Interobserver agreement was researched for each one of the classifications and for the indication of treatment with the use of CT scan and x-ray thereafter. The Kappa evaluation showed the same range of agreement (0.20 to 0.39) on both examinations. There were less indications of non-surgical treatment (23 indications with CT scan against 41 with the x-ray) and an increased number of indications of more complex forms of treatment when CT scan was analysed. It is concluded that CT scan and radiography have similar levels of interobserver agreement for classification and indication of treatment of fractures of the distal end of the radius. CT scan showed to be an useful method for initial evaluation and for indication of treatment of fractures of the distal end of the radius and that it changed this indication in a significant way when compared to xray.