| چکیده انگلیسی مقاله |
Background: The purpose of this study was to determine whether Multi-Detector Computed Tomography (MDCT) in addition to plain radiographs influences radiologists' and orthopedic surgeons' diagnosis and treatment plans for delayed ::union::s and non-::union::s. Methods: A retrospective database of 32 non-::union::s was reviewed by 20 observers. On a scale of 1 to 5, observers rated on X-Ray and a subsequent Multi Detector Helical Computer Tomography (MDCT) scan was performed to determine the following categories: "healed", "bridging callus present", "persistent fracture line" or "surgery advised". Interobserver reliability in each category was calculated using the Interclass Correlation Coefficient (ICC). The influence of the MDCT scan on the raters' observations was determined in each case by subtracting the two scores of both time points. Results: All four categories show fair interobserver reliability when using plain radiographs. MDCT showed no improvement, the reliability was poor for the categories "bridging callus present" and "persistent fracture line", and fair for "healed" and "surgery advised". In none of the cases, MDCT led to a change of management from nonoperative to operative treatment or vice versa. For 18 out of 32 cases, the treatment plans did not alter. In seven cases MDCT led to operative treatment while on X-ray the treatment plan was undecided. Conclusion: In this study, the interobserver reliability of MDCT scan is not greater than conventional radiographs for determining non-::union::. However, a MDCT scan did lead to a more invasive approach in equivocal cases. Therefore a MDCT is only recommended for making treatment strategies in those cases. |
| نویسندگان مقاله |
| Ydo V. Kleinlugtenbelt
Department of Orthopaedic and Trauma Surgery, Joint
Research Onze Lieve Vrouwe Gasthuis, Amsterdam, the
Netherlands.
Division of Orthopaedic Surgery, McMaster University,
Canada.
Department of Orthopaedic and Trauma Surgery,
Deventer ziekenhuis, Deventer, the Netherlands
| Vanessa A.B. Scholtes
Department of Orthopaedic and Trauma Surgery, Joint
Research Onze Lieve Vrouwe Gasthuis, Amsterdam, the
Netherlands
| Jay Toor
Division of Orthopaedic Surgery, McMaster University,
Canada
| Christian Amaechi
Department of Orthopaedic and Trauma Surgery, Joint
Research Onze Lieve Vrouwe Gasthuis, Amsterdam, the
Netherlands
| Mario Maas
Department of Radiology, Academic Medical Center,
University of Amsterdam, Amsterdam, the Netherlands
| Mohit Bhandari
Division of Orthopaedic Surgery, McMaster University,
Canada
| Rudolf W. Poolman
Department of Orthopaedic and Trauma Surgery, Joint
Research Onze Lieve Vrouwe Gasthuis, Amsterdam, the
Netherlands
| Peter Kloen
Department of Orthopaedic and Trauma Surgery, Academic
Medical Centre, University of Amsterdam, Amsterdam, the
Netherlands
|