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Interobserver variability in the treatment of little finger metacarpal neck fractures
Rick Tosti1, Asif M Ilyas1, Jos J Mellema1
1Department of Orthopaedic Surgery and Sports Medicine, Temple University School of Medicine; the Rothman Institute, Thomas Jefferson University, Philadelphia, PA; Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA.
Purpose:
To address the null hypothesis that surgeons shown radiographs of little finger metacarpal neck fractures with measured fracture angulation would recommend surgery as often as surgeons shown unmarked radiographs.
Methods:
Members of the Science of Variation Group, an international collaboration of fully trained orthopedic and trauma surgeons, were asked to review 20 little finger metacarpal neck fracture cases, which included a vignette and 3 high-quality radiographs. Members were then randomized to review radiographs with or without measured fracture angulation on the lateral view and select operative or nonoperative management.
Results:
Surgeons shown radiographs with measured angulation were more likely to recommend surgery, and there was less variability among these surgeons, particularly for fractures with less angular deformity.
Conclusions:
Measured fracture angulation has a small but significant influence on treatment recommendations for little finger metacarpal neck fractures.
Type Of Study/Level Of Evidence:
Diagnostic III.
