ASSESSMENT OF RADIOLOGICAL HEALING RELIABILITY AND ACCURACY IN DISTAL RADIUS FRACTURES
Bibliographic record
Abstract
Distal radius fractures (DRFs) are commonly managed non-operatively through closed reduction and cast immobilization; however, complications may arise if the immobilization period is too long or short. There are no standardized guidelines to determine the optimal duration of immobilization, so radiographic assessment of healing progression is common. However, there is no consensus on criteria to assess union. Scoring cortical continuity has been used with some success in lower limb fractures,1 but it remains unclear if a similar technique can reliably determine union after DRFs. In this study, we hypothesized that radiographic assessment based on cortical continuity and fracture line visibility of non-operatively treated DRFs would provide a reliable measure of fracture healing. We assessed inter- and intra-rater reliability of radiographic scoring, with and without access to patient demographics and injury characteristics. We also determined the association of radiographic scoring against Patient-Rated Wrist Evaluation (PRWE) and predictions of bone stiffness. Consecutive adults who underwent non-operative treatment for a DRF were enrolled in this prospective cohort study. Orthogonal radiographs were taken at initial assessment and 2-weeks, 4–6 weeks, and 26-weeks post-fracture. Six independent raters (two attending surgeons, two orthopaedic trauma fellows, and two senior residents) determined radiographic cortex score (RCS) based on callus and fracture line visibility. Raters scored each image thrice, with a minimum two-week washout period between scorings. Patient and injury information was provided at the third scoring. Raters also scored fracture union and whether the cast should be removed (yes/no responses). Intra-class correlation coefficients (ICC) and repeated measures correlation coefficients (rm) were calculated for within and between raters. PRWE was collected at each timepoint, as was a high-resolution peripheral quantitative computed tomography (HR-qQCT) image of the wrist (61 μm isotropic resolution). The latter was used to develop image-based micro-finite element models (μFE) to estimate apparent stiffness under uniaxial compression and torsional loading. Twenty participants (18 female, mean age = 50.5 ± 15.8 years) were enrolled. As shown in Figure 1, the inter-rater agreement was fair at the first and second round, with respective ICCs of 0.69 and 0.68. Inter-rater agreement was stronger at the third round, when patient information was provided (ICC=0.80). Finally, inter-rater agreement for the RCS was consistently stronger than the agreement for union or cast removal. Finally, RCS was strongly associated with μFE-estimated stiffness (rm = 0.74 to 0.84) and PRWE (rm = −0.83 to −0.75). Intra-rater reliability across the first two rounds and rounds one and three were stronger for RCS (mean ICC = 0.69 and 0.73, respectively) than fracture union (ICC = 0.57 and 0.56, respectively) or cast removal (ICC = 0.51 and 0.49, respectively). RCS had fair-to-good inter-rater reliability, across multiple rounds of scoring. Scores were strongly associated with μFE-estimated stiffness and PRWE, suggesting it is a good measure of mechanical and function changes indicative of healing. We observed weaker reliability of more subjective determination of fracture union and the decision to continue cast immobilization. Thus, we recommend the use of the RCS to aid clinical decision-making in non-operatively treated DRFs. For any figures or tables, please contact the authors directly.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".