Digital radiographs in the assessment of distal radius fracture parameters

The purpose of the current study was to assess the reliability of measurement of distal radius fracture parameters using digital radiographs. Digital radiographs and corresponding plain radiographs of the wrists of 20 patients with intraarticular distal radius fractures were used to measure radial inclination, palmar tilt, radial height, and articular step-off. The plain radiographs and digital images were evaluated independently by three examiners in two sessions. The plain radiographs were assessed using a standard goniometer (manual measurements) whereas the digitized radiographs were evaluated using imaging software to do the computer-assisted measurements. The interobserver and intraobserver reliability were measured using repeated measures analysis of variance and weighted kappa statistics. Measurement of the digital images improved the interobserver reliability of measurement of palmar tilt from substantial to excellent, radial height from moderate to substantial, and articular step-off from fair to moderate. Similarly, intraobserver reliability increased from moderate to substantial when measuring radial height. In no instance (between or within observers) did the level of reliability decrease when using digital images for fracture evaluation. The current data suggest that the reliability of measurements of angular and linear fracture parameters of distal radius fractures is similar between plain and digital radiographs.