589045 research-article2015
JHS0010.1177/1753193415589045Journal of Hand Surgery (European Volume)Short report letter
JHS(E)
Short report letter
The Journal of Hand Surgery (European Volume) XXE(X) 1–2 jhs.sagepub.com
Assessing the ages of delayed unions and non-unions of the scaphoid on plain radiographs: apparently unreliable Dear Sir, The scaphoid is the most commonly fractured carpal bone, accounting for 60% of carpal injuries (Robbins et al., 1995). There is an appreciable incidence of non-union, 5%–10%, with non-surgical treatment (Herndon, 1994). The age of the non-union (i.e. the time from injury) may be known, but patients often present with no history, or only a vague history, of previous injury (Nakamura et al., 1993). It is also not uncommon for patients with a long-standing nonunion to present in the clinic, after a recent injury, convinced that they have a fresh fracture. If the age of the non-union cannot be established reliably from the history then it is often estimated, based on interpretation of the radiographic changes. Although longstanding non-unions may be associated with the various changes of scaphoid non-union advanced collapse (Vender and Watson, 1987), any earlier changes in response to non-union are not established. The aim of this study was to assess the accuracy of predicting the age of scaphoid non-union from radiographs. After obtaining statistical advice, 24 good quality radiographs of scaphoid non-unions with a known date of injury were placed in an online questionnaire. The images were categorized into six groups, with four cases in each group, according to the age of the delayed union (6–12 weeks) or non-union (>12 weeks); the time from injury of the non-unions were 3–6 months, 6–9 months, 9–12 months, 12–24 months and >24 months. There were 16 cases with a nonunion 1 year old. The 24 images were reviewed independently in random order and without a time limit by orthopaedic and plastic hand surgeons. The assessors were not told of the numbers in each group. All patient information was deleted and observers were blinded to demographic and clinical information. A total of 30 consultant surgeons attempted the questionnaire. All the images
were assessed. There were 28 orthopaedic hand surgeons and two plastic hand surgeons. Most plastic surgeons who were approached declined to participate as they did not treat scaphoid fractures. The data were distributed normally and therefore the statistical tests used were one-way ANOVA (analysis of variance) test, the one sample t-test, and Fleiss’ kappa. For all the categories of delayed or non-union, the inter-rater reliability between the consultants of the kappa value was only 0.148. This signifies that there was only slight agreement between consultants when assessing the ages of fractures. The surgeons were not reliable at assessing the ages of delayed or non-unions
JHS0010.1177/1753193415589045Journal of Hand Surgery (European Volume)Short report letter
JHS(E)
Short report letter
The Journal of Hand Surgery (European Volume) XXE(X) 1–2 jhs.sagepub.com
Assessing the ages of delayed unions and non-unions of the scaphoid on plain radiographs: apparently unreliable Dear Sir, The scaphoid is the most commonly fractured carpal bone, accounting for 60% of carpal injuries (Robbins et al., 1995). There is an appreciable incidence of non-union, 5%–10%, with non-surgical treatment (Herndon, 1994). The age of the non-union (i.e. the time from injury) may be known, but patients often present with no history, or only a vague history, of previous injury (Nakamura et al., 1993). It is also not uncommon for patients with a long-standing nonunion to present in the clinic, after a recent injury, convinced that they have a fresh fracture. If the age of the non-union cannot be established reliably from the history then it is often estimated, based on interpretation of the radiographic changes. Although longstanding non-unions may be associated with the various changes of scaphoid non-union advanced collapse (Vender and Watson, 1987), any earlier changes in response to non-union are not established. The aim of this study was to assess the accuracy of predicting the age of scaphoid non-union from radiographs. After obtaining statistical advice, 24 good quality radiographs of scaphoid non-unions with a known date of injury were placed in an online questionnaire. The images were categorized into six groups, with four cases in each group, according to the age of the delayed union (6–12 weeks) or non-union (>12 weeks); the time from injury of the non-unions were 3–6 months, 6–9 months, 9–12 months, 12–24 months and >24 months. There were 16 cases with a nonunion 1 year old. The 24 images were reviewed independently in random order and without a time limit by orthopaedic and plastic hand surgeons. The assessors were not told of the numbers in each group. All patient information was deleted and observers were blinded to demographic and clinical information. A total of 30 consultant surgeons attempted the questionnaire. All the images
were assessed. There were 28 orthopaedic hand surgeons and two plastic hand surgeons. Most plastic surgeons who were approached declined to participate as they did not treat scaphoid fractures. The data were distributed normally and therefore the statistical tests used were one-way ANOVA (analysis of variance) test, the one sample t-test, and Fleiss’ kappa. For all the categories of delayed or non-union, the inter-rater reliability between the consultants of the kappa value was only 0.148. This signifies that there was only slight agreement between consultants when assessing the ages of fractures. The surgeons were not reliable at assessing the ages of delayed or non-unions
