ShoulderAdditional x-ray views increase decision to treat clavicular fractures surgically
Section snippets
Methods
Standard radiographic studies of the clavicle at our institution include 4 views (AP, 20° cephalad, 45° cephalad, and 45° caudad) (Fig. 1). Radiographs, including all 4 views, were collected for 50 consecutive patients with confirmed acute midshaft fractures of the clavicle. The image groupings were de-identified and assigned a study identification number. The image files were separated into two folders, one including standard 2-view images (AP and 20° cephalad)1 and one including all 4 images.
Results
The ICC for interobserver reliability of treatment decisions for the 2-view analysis was 0.87 (95% confidence interval [CI], 0.80-0.92). Table I provides the κ values for direct comparison of reviewers. From this analysis, we found that all κ values were greater than or equal to 0.50 and the highest agreement was observed between the shoulder and elbow fellow and fellowship-trained surgeon. The second review provided a lower ICC for interobserver reliability (0.65; 95% CI, 0.53-0.76). The
Discussion
The decision to treat closed midshaft clavicular fractures either operatively or nonoperatively is heavily dependent on radiographic fracture displacement.1, 2 However, the traditional trauma series for clavicular fractures includes only an AP radiograph and a single cephalic or caudal tilt radiograph.3, 4, 5 This may be partially because of the cost of additional views. Regardless, it is our opinion that the degree of fracture displacement cannot be adequately determined on these 2 views
Conclusions
The standard 2-view clavicular radiographic trauma series underestimates AP displacement. With the use of a novel 4-view radiographic series (standard 2 views plus orthogonal views), surgeons are more likely to treat clavicular fractures operatively and their intraobserver reliability is improved.
Disclaimer
The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.
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Optimizing the radiographic technique in clavicular fractures
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Cited by (0)
The Thomas Jefferson University Institutional Review Board granted approval for this study (control No. 09R.229).